Denial rate benchmarks 2026

The 2026 industry denial rate is 9%, according to the AMS Solutions State of Medical Billing 2026 benchmark report. The same report puts average days in accounts receivable (A/R), the time between billing and collection, at 42 days. Experian Health's State of Claims 2025 adds another warning: 41% of providers report that more than 10% of their claims are denied.

Those numbers are useful only when the denominator is consistent. For a first-pass denial rate, divide claims denied on their first payer decision by all claims with a first payer decision during the same period. Do not mix encounters, claim lines, resubmissions, or unresolved claims unless the benchmark uses the same unit.

A practice can also report a low final denial rate while carrying weak controls. Corrected claims may eventually pay after several touches, increasing labor and days in A/R. Underpayments may post as paid and never enter a denial report. Patient responsibility may be assigned correctly but never collected. None of those losses is visible in a narrow denial percentage.

For a behavioral health group, track at least four measures together: first-pass denial rate, final write-off rate, days in A/R, and payment variance against contracted rates. Segment them by payer, clinician, location, and denial reason. A blended practice-wide percentage can hide one payer or workflow causing most of the damage.

Use the 9% industry figure and the common 5% target as screening points, not verdicts. The better question is whether every remit can be traced to the expected contracted amount and then to a deposit. That reconciliation separates processing noise from revenue that needs action.

First Pass Paid is building claim checks and a denial worklist for this. Join the early access list.

Sources

• AMS Solutions, State of Medical Billing 2026
• Experian Health, State of Claims 2025