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The study investigates how medical claim denial rates differ by payer and provider type, focusing on safety-net providers.

August 8, 2026Health Affairs ScholarOpen Access

Variation in Medical Claim Denials: Safety-Net Providers are Hardest Hit

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The study investigates how medical claim denial rates differ by payer and provider type, focusing on safety-net providers.
Utilized a multipayer claims dataset from 2019.
Examined initial denials, appeal patterns, and final denials by payer segment, service type, and provider safety-net status.
Compared denial rates across professional, inpatient, and outpatient claims.
Medicaid managed care had the highest initial denial rate for professional claims at 15.1 percent.
Medicare Advantage showed the highest rates for inpatient (20.0 percent) and outpatient (16.5 percent) claims.
Safety-net providers had higher initial denial rates compared to non-safety-net providers across all service types.

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Analysis examines claim denial rates in safety-net providers, highlighting significant disparities in payer interactions.

Weinreb et al. (2026) studied this question.

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