The “Why” Behind Denials and a Bold Vision for Prevention 

Few things generate more payer–provider friction than claim denials. According to the Availity Abrasion Index, denials are a leading source of friction, driving rework, slowing reimbursement, and fueling mistrust across the revenue cycle. This point of friction isn’t just an operational headache—it’s a systemic bottleneck that pulls focus away from patient care. 

In this Q&A, Linda Perryclear, Senior Director of Product Management at Availity, explains what’s driving denials, why throwing automation at broken processes won’t fix the issue, and how a shift to improving claim administration upstream could reduce denials—starting right in the doctor’s exam room. 

The Availity Abrasion Index shows that denials rank among the highest sources of friction for both payers and providers, cutting across roles, organizations, and processes. Where do revenue cycle leaders feel the most friction today when it comes to working with payers? 

Ninety percent of providers surveyed said denials were a major source of strain. From their perspective, there’s an expectation that a claim will be denied, and that both the reason and the path to resolution will be unclear. That ambiguity creates friction, drives unnecessary rework, and slows the entire reimbursement process. 

Is that caused more by process or technology? Mix of both? 

A mix of both, but the bigger challenge is how fast the landscape is changing. Something that wasn’t denied three months ago may be denied today. Providers are left asking ‘Why? What has changed? How do you resolve it? How do you prevent it from happening ?’ The technology isn’t keeping pace for either side. Many processes still rely on knowledge carried by a couple of people within a provider’s organization. What might help the process is some automation. But while automation can speed up individual steps, automating a broken process doesn’t solve the problem’s root causes.  

What do you think the role of AI should be in prevention and then post-denial? 

The role of AI should be to identify the root causes of problems and surface patterns that humans can’t easily see. The most sophisticated technology—such as AI—should not only be used is not best used on repetitive, low-value tasks like fixing thousands of claims in milliseconds (that is a great use case for automation). AI is also great at identifying patterns and generating insights. Once you understand the root cause of the problem, there may be a case for a simpler, lower-cost automation to resolve it. But AI could help us actually identify and change the pattern so we can prevent problems, not just react to them. 

Download the Availity Abrasion Index to learn more about how payers and providers can address friction.

The Availity Abrasion Index highlights a reality across healthcare: both payers and providers spend a tremendous amount of time and resources working through denials. Why is this process so abrasive for both? 

The tension often comes down to perceived intent. Providers may think the intent of the payer is to deny claims, while payers may feel providers are trying to game the system. That erodes trust and makes it harder to come together and say, ‘let’s solve the real problem.’  

In the Availity Abrasion Index, some providers and payers said denials feel less like exception handling and more like a standing layer of the current reimbursement mode. Does that ring true for you?  

From the provider perspective, yes. Denials can feel more like a standing layer of the reimbursement process. Payers may view them as a necessary mechanism to manage cost and ensure appropriate care. What the Availity Abrasion Index makes clear, though, is that both sides agree denials are a recurring source of friction. That shared acknowledgment is the best place to start solving the problem and center the focus on patient care. 
 

What would it look like if we moved more toward denial prevention “upstream,” a model that could prevent denials and address the mistrust? 

My nirvana, as a revenue cycle nerd, is this: during a patient exam, there’s technology in the room that can capture what happens in that visit. That technology also has the ability to see that patient’s history. The technology combs through information and creates a claim that accurately reflects what happened during a clinical encounter. That leads to a touchless, accurate payment from a health plan to a provider. The patient is never left wondering or worrying about a surprise bill or the cost of care, so they can focus on being healthy. That’s the future we all want. 

 
When it comes to denials, what do you hope providers and payers take away from the Availity Abrasion Index? 

My hope for the Availity Abrasion Index is that it shows there’s a real path to rebuilding trust, to resolving real problems. Providers are focused on caring for one patient at a time. Payers are focused on caring for member populations and keeping coverage affordable. When we recognize that those intentions are aligned, and start using the same language, we can actually come together to reduce friction and solve real problems.  

About Linda Perryclear

Linda Perryclear is the Senior Director of Product Management at Availity. She is responsible for the Essentials Pro solution and post-submission claims management. Since joining Availity in 2004, Linda has held various positions in the organization including director of the provider support organization, as well as roles in client experience and account management. Throughout her career, Linda has worked in healthcare in both administrative and clinical roles, and also served in the US Navy for six years as a hospital corpsman. She holds a bachelor’s degree in finance and risk management from UNC Charlotte and works from her home base in North Carolina.