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Denial benchmarksA good denial rate is one that's falling on your own definition, payer by payer. Here's what the published benchmarks measure, so you compare your number with the right one.
There's no official standard. As of October 2026, published initial denial rates sit around 8% for single-specialty medical practices (MGMA, 2023 data) and about 12% to 15% for hospitals (Kodiak, 2024 data; Premier, 2023 claims). A good rate beats those on the same definition, keeps falling, and turns into very few final denials written off.
Most arguments about denial rates are really arguments about definitions. Read the "measures" column before you compare.
| Figure | Source and date | Who's counted | Measures |
|---|---|---|---|
| 8% of claims denied on first submission | MGMA DataDive, 2023 data (MGMA Stat, March 2024) | Single-specialty medical groups | Initial denials, by claim count |
| 11.81% initial denial rate in 2024 | Kodiak Solutions, May 2025 (vendor platform data) | 2,100+ hospitals and 300,000 physicians on its platform | Initial denials |
| Nearly 15%, ranging as high as 49% | Premier, February 2025 (vendor survey) | 280 hospitals, 2023 claims | Initial denials |
| 41% of providers report denial rates of 10% or higher | Experian Health, September 2025 (vendor survey) | 250 revenue cycle professionals | Self-reported share of providers above 10% |
| 2.7% median final denial rate in 2025 | Kodiak Solutions, March 2026 (vendor platform data) | 2,300+ hospitals | Denials never paid, the money you lose |
| 19% of in-network claims denied in 2024 | KFF, March 2026 | HealthCare.gov marketplace insurers | Payer-reported final denials on enrollee claims |
Most of these come from vendors that sell revenue cycle products, and the method notes are short. Use them as a range to place yourself in.
You'll also see "keep denials under 5%" quoted as an industry standard. We couldn't find a published source with a method behind it, so we don't use it.
HFMA's Claim Integrity Task Force set standard formulas so providers can compare like with like.
Initial denial rate by count = initial denial claims ÷ total claims submitted, using the average claims submitted over the 3 months before the reporting month. Only the first denial on a claim counts, and rebills are left out.
Initial denial rate by dollars = initial denial gross charges ÷ total claim gross charges, on the same basis.
HFMA's recommended best practice also tracks denials at the line level, by claim adjustment reason code. A claim that's paid except for one line still has a denial worth knowing about.
| What you see | What it likely means | What to do |
|---|---|---|
| Initial rate under the benchmark for your setting, and falling | Front-end controls are working | Keep tracking by payer; watch for one payer drifting up |
| Initial rate near the benchmark, final rate low | Your team overturns most of what's denied | Count the cost of that rework; Premier put it at $57.23 per contested claim for 2023 claims |
| Initial rate fine, final rate rising | Denials are going unworked or past filing limits | Check backlog age against appeal deadlines |
| One payer or denial class far above the rest | A payer rule, contract term or front-end gap | Root-cause that class first; it's usually cheaper to prevent than to appeal |
| Rate jumps after a system change | Mapping, coding or eligibility setup problem | Audit claims from the change date |
Final denials are what reach your margin. Kodiak reports that clinical denials, such as prior authorization and medical necessity, drove nearly all of the 2025 increase in revenue lost to final denials and bad debt.
A 10% blended rate can hide a 30% rate at one payer. Kodiak's March 2026 release says Medicare Advantage plans had initial and final denial rates more than double traditional Medicare's.
Split your rate by payer, by denial reason code and by department of origin. That's where the fixes are. How to evaluate a healthcare RCM partner has a measure set you can use with any vendor, and what a denied claim costs shows below what value an appeal loses money.
TSI's denial management team classifies each denial by payer, reason code, CPT and department of origin, works the appeals, and brings the root causes to monthly reviews with your revenue cycle leaders. You see denial trends and appeal results in the client portal.
Results vary by payer mix and client program.
Recent published figures put hospital initial denial rates at about 11.8% (Kodiak, 2024 data, 2,100+ hospitals) to nearly 15% (Premier, 2023 claims, 280 hospitals). Both are vendor figures with different methods.
An initial denial is the payer's first "no" on a claim. A final denial is one that's never paid after appeals and corrections. Initial rates show how much rework enters the queue; final rates show the money you lose.
Both. HFMA's standard defines the initial denial rate both ways. A low count rate with a high dollar rate usually means large inpatient or specialty claims are being denied.
Monthly at least, split by payer and reason. A single quarterly blended number moves too slowly to catch a payer change.
General information, current as of Nov 5, 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The Denials Economics Sprint takes one payer and one denial class, sets a baseline and reports overturn rate, paid yield, cost per claim and the claim value below which appeals lose money.
