Across the U.S. healthcare system, claim denials continue to rise at a rate that is as unsustainable as it is avoidable. The newest 2025 Experian State of Claims Report reveals an uncomfortable truth: the majority of denials originate from bad or incomplete data, much of it upstream in provider information. And both payers and billing companies are carrying the financial and operational burden of rework.
While technology has advanced, the data behind the technology has not — and it shows.
The Denial Problem Is Worsening — And Data Quality Is the Culprit
The report confirms what billing teams and payer organizations experience daily:
- Missing or inaccurate claim data is the #1 cause of denials (50%).
- Incorrect registration/provider data is the #3 cause of denials (32%).
- Claim errors are increasing for 54% of organizations, and
- Submitting clean claims is harder for 68% of respondents compared to last year.
- 26% say that 10% or more of their denials result from inaccurate or incomplete intake data, including provider details.
For billing companies, this means more time spent correcting claims instead of driving revenue.
For payers, it means higher administrative costs, delayed reimbursements, and growing compliance exposure.
Both sides are paying, quite literally, for the same upstream problem.
The True Cost of Rework: An Expensive, Manual, Repetitive Cycle
Denials don’t just slow operations. They consume meaningful labor and budgets:
- 90% of denied claims require human review before resubmission, keeping teams stuck in manual work queues.
- Fragmented systems worsen the problem:
81% of organizations use two or more systems to collect information for claims, increasing the chance of mismatches.
These inefficiencies compound daily.
Every inaccurate provider address, incorrect affiliation, outdated taxonomy, or mismatched NPI becomes another denied claim, and another drain on the bottom line.
For billing companies operating on thin margins, the impact is direct: more rework, more staff hours, and more revenue leakage.
For payers measured on auto-adjudication rates and operational efficiency, the impact is systemic: slower cycles, higher cost per claim, lower accuracy, and mounting risk.
Why the Industry Must Rethink Provider Data
The report makes one point unmistakably clear: the industry cannot reduce denials without fixing the quality of provider data feeding the claim.
The most advanced adjudication engine cannot overcome incorrect NPIs, mismatched locations, missing affiliations, or outdated network status.
Clean claims start with clean provider data.
This is where Polus HCP changes the equation.
How Polus™ HCP Eliminates the Cost of Bad Provider Data
An efficiency engine for payers and billing organizations, Polus HCP was built to address one of the root causes of denial-driven waste: fragmented, inaccurate, manually maintained provider data.
While the Experian report illustrates the rising operational burden, Polus HCP provides a practical and immediate path to relief.
1. Eliminating Upstream Data Errors Before They Become Denials
Polus ingests provider data from every relevant source — directories, credentialing files, NPPES, claims, licenses, and more — and applies:
- AI-driven validation
- Standardization & normalization
- Enrichment of missing fields
- Continuous accuracy scoring
By resolving provider information discrepancies before the claim is generated, Polus dramatically reduces the leading causes of denials documented in the report:
- inaccurate claim data
- incorrect provider registration information
- incomplete data at intake
2. Reducing Rework Through a Trusted Source of Truth
Billing teams no longer spend hours correcting the same errors repeatedly.
Payers no longer maintain parallel systems filled with conflicting provider records.
A single, authoritative dataset means:
- fewer manual touches
- fewer eligibility reruns
- fewer rejected claims
- faster reimbursement cycles
3. Increasing Operational Efficiency for Both Sides of the Ecosystem
For Billing & Coding Companies:
- Higher clean-claim rates
- Increased staff productivity
- Improved margins
- Faster days-to-payment
- Reduced operational burnout
For Payers:
- Higher auto-adjudication rates
- Lower administrative costs
- Reduced dependency on manual review
- Stronger compliance footing
- Fewer “avoidable denials” — the most expensive category
4. Strengthening Compliance While Lowering Exposure
Bad provider data doesn’t just cause denials.
It creates risk.
Polus ensures that payer directories, claims, and internal systems share consistent, validated provider data — supporting audit readiness and reducing the likelihood of downstream penalties or remediation.
The ROI: Clean Data Pays for Itself
When 50% of denials originate from inaccurate data, and 90% require human rework, an automated, authoritative, continuously updated provider dataset is no longer optional.
It is the fastest path to measurable financial return.
Across payers and billing organizations, the ROI shows up in:
- Reduced cost of rework
- Lower administrative burden
- Higher clean-claim rates
- Faster cash flow
- Reduced denial volume
- Improved resource allocation
Every avoided denial is reclaimed revenue.
Every clean claim is saved time.
Every accurate provider record is reduced risk.
Fixing Provider Data Fixes Denials
The 2025 State of Claims report couldn’t be clearer: bad data is accelerating denials, increasing operational waste, and weakening financial performance across the healthcare ecosystem.
Polus HCP delivers the accuracy, completeness, and trustworthiness the system has been missing — transforming provider data from a liability into an operational advantage.
When provider data becomes reliable, denials decline.
When denials decline, efficiency returns.
And when efficiency returns, both billing companies and payers win.
Learn more about Polus HCP