Denials keep rising. Start the fix at the point of care.
What the 2026 State of Claims survey found, why coding and documentation gaps surface weeks later as denials, and how to tie every code to the evidence behind it.
Experian Health's 2026 State of Claims survey, published on October 28, 2026, asked 204 leaders responsible for billing and claims how things are going. 75% said denials are increasing, 68% said their denial rate is higher than a year ago, and 40% said more than 10% of their claims are denied, largely unchanged from last year1.
The top causes they cited were services not covered by insurance, missing coverage information, coding errors, changing payer policies and prior authorization issues1. Several of those begin long before a claim is built.
Why denials begin in the exam room
A coding error is usually found by a payer weeks after the visit. It is usually made much earlier, when a code is chosen by someone who was not in the room, from a note that does not clearly show what supports it. A level of service needs documentation that shows how it was reached. A diagnosis needs to match what was actually assessed. When the note is thin, the code is a guess, and the denial arrives later as rework.
AI helps only if you can see why
Revenue-cycle leaders are ready for help: 84% believe AI can improve claims management, 64% plan to invest in AI for claims and denials, and 83% would replace their current technology for a compelling return1. But a suggested code that no one can trace back to the record is not a fix. It moves the risk from a denial to an audit.
The useful test for any coding assistant is simple: for each suggested code, can a coder see the exact words in the documentation that support it, and confirm or change it before anything is billed?
What to set up before 2027
- Suggest codes at the point of care, while the clinician can still add what is missing.
- Link every suggestion to its evidence in the transcript and the note.
- Keep a certified coder in the loop to confirm before billing, and log every change.
- Sign the same day, so claims are built from complete, signed documentation.
- Sort denials by root cause each month and trace coding denials back to the visits they came from.
Built for the whole visit, not just the note
Dictora suggests ICD-10, CPT and E/M codes while the visit is fresh, and ties each one to the words in the transcript and note that support it. The E/M helper shows how a level was reached, and a certified coder confirms every code before anything is billed.
When the visit is signed, the note, orders and patient instructions are signed together, every action is audit-logged, and filing to the EHR is tracked until a receipt comes back.
Sources
- Experian Health, "Experian Health’s Annual State of Claims Survey Finds Denials Remain Elevated As Reimbursement Challenges Grow" (October 28, 2026). Source
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