2025 analysis shows denial activity increasingly occurs outside traditional remittance reporting and extends months beyond payment.
MILWAUKEE, Feb. 26, 2026 /PRNewswire/ — Sift Healthcare, a healthcare payments intelligence company focused on helping health systems better understand and manage reimbursement complexity, today released its Fourth Annual Denials Insights Report, an analysis of emerging payer adjudication patterns and denial trends observed across millions of claims in 2025.
Now in its fourth year, the annual report examines how reimbursement risk is evolving beyond traditional denial rate reporting. Sift’s analysis identifies nine structural trends affecting health system revenue performance, including shifts in DRG downgrade patterns, payer-specific documentation scrutiny, and delayed post-payment recovery activity.
Unlike traditional benchmarking reports that emphasize aggregate denial percentages, Sift’s analysis focuses on adjudication logic, isolating where revenue loss is introduced, how payer policy enforcement varies, and how risk surfaces across the revenue cycle.
“Traditional denial reporting infrastructure was built for a different reimbursement environment,” said Justin Nicols, Founder and CEO of Sift Healthcare. “What we’re seeing in our data is a structural shift in how revenue risk for healthcare providers surfaces. Today, denial activity is increasingly moving upstream and becoming fragmented across workflows, in some cases long after payment is assumed final.”
The report highlights structural shifts in payer behavior, including:
- Rises in DRG downgrades driven by clinical validation scrutiny
- Increased payer-specific variation in documentation interpretation
- Growth in automated takebacks and post-payment recoupments
- Variation in overturn rates across payers and service lines
- Expansion of AI-assisted adjudication and policy enforcement by payers
“As payers leverage increasingly sophisticated technologies to make reimbursement decisions further upstream, healthcare providers will require advanced payment intelligence solutions to streamline denial management workflows,” continued Mr. Nicols. “At Sift, we are committed to helping healthcare providers do just this, leveraging our RevProtect intelligence to help providers quickly predict, prevent and resolve reimbursement risk to improve overall financial outcomes.”
Sift publishes the Denials Insights Report annually to provide revenue cycle, revenue integrity, and finance leaders with an independent view of payer behavior trends observed across adjudicated payment data.
The full report is available for download at https://www.sifthealthcare.com/denial-insights.
About Sift Healthcare
Sift Healthcare is a healthcare payments intelligence company focused on helping health systems better understand and manage reimbursement complexity. Sift’s RevProtect platform brings together clinical, authorization, coding, and payment data to deliver actionable insights that support denial prevention, payment accuracy, and revenue cycle optimization.
Sift works with healthcare organizations to apply advanced analytics and AI in ways that are grounded in real-world clinical and operational workflows.
Follow Sift Healthcare:
www.sifthealthcare.com
www.linkedin.com/company/sift-healthcare
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SOURCE Sift Healthcare
