{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T02:21:07Z","timestamp":1793154067913,"version":"4.5.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute Aging","award":["5P01AG032952"],"award-info":[{"award-number":["5P01AG032952"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Medical claim denials impose substantial costs on providers but may also reduce low-value care, resulting in lower expenditures and better quality. Little is known about how denial rates vary across payer and provider segments, including for safety-net providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a large, multipayer claims dataset from 2019, we examined initial denials, appeal patterns, and final denials by payer segment, service type, and provider safety-net status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Medicaid managed care had the highest initial denial rate for professional claims (15.1%), while Medicare Advantage had the highest rates for inpatient (20.0%) and outpatient (16.5%) claims. Safety-net providers faced uniformly higher initial denial rates than nonsafety-net providers across professional (13.6% vs 9.2%), inpatient (18.3% vs 14.7%), and outpatient (13.3% vs 12.9%) services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Safety-net providers absorbed a disproportionate share of denial costs. These providers\u2019 lack of negotiating leverage to secure favorable terms with payers could be 1 driver of these disparities, as could higher rates of low-value care delivery. A standardized framework for the terms and conditions governing payer\u2013provider contracts could help ensure all claims are decided based on the same set of rules.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag206","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:52:54Z","timestamp":1786017174000},"source":"Crossref","is-referenced-by-count":1,"title":["Variation in medical claim denials: safety-net providers are hardest hit"],"prefix":"10.1093","volume":"4","author":[{"given":"Gabe G","family":"Weinreb","sequence":"first","affiliation":[{"name":"Health Policy and Management, Harvard Business School , Boston, MA 02163 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4912-0647","authenticated-orcid":false,"given":"Bruce E","family":"Landon","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Beth Israel Deaconess Medical Center , Boston, MA 02215 ,","place":["United States"]},{"name":"Department of Health Care Policy, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"2026082010363979400_qxag206-B1","author":"House Committee on Energy and Commerce"},{"key":"2026082010363979400_qxag206-B2","author":"Addabbo"},{"key":"2026082010363979400_qxag206-B3","author":"House Committee on Education and the Workforce, Democrats"},{"key":"2026082010363979400_qxag206-B4","author":"Premier"},{"issue":"4","key":"2026082010363979400_qxag206-B5","doi-asserted-by":"publisher","first-page":"273","DOI":"10.7326\/0003-4819-138-4-200302180-00006","article-title":"The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care","volume":"138","author":"Fisher","year":"2003","journal-title":"Ann Intern Med"},{"issue":"5","key":"2026082010363979400_qxag206-B6","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1162\/rest_a_01339","article-title":"Can whistleblowers root out public expenditure fraud? Evidence from medicare","volume":"107","author":"Leder-Luis","year":"2025","journal-title":"Rev Econ Stat."},{"key":"2026082010363979400_qxag206-B7","author":"Centers for Medicare & Medicaid Services"},{"key":"2026082010363979400_qxag206-B8","author":"Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et Al. (2025)"},{"key":"2026082010363979400_qxag206-B9","author":"Kisting-Leung et al. v. Cigna Corporation et Al. (2025)"},{"key":"2026082010363979400_qxag206-B10","author":"Blumenthal R"},{"issue":"1","key":"2026082010363979400_qxag206-B11","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1093\/qje\/qjad035","article-title":"A denial a day keeps the doctor away","volume":"139","author":"Dunn","year":"2024","journal-title":"Q J Econ."},{"issue":"6","key":"2026082010363979400_qxag206-B12","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1377\/hlthaff.2024.01485","article-title":"Medicare Advantage denies 17 percent of initial claims; most denials are reversed, but provider payouts dip 7 percent","volume":"44","author":"Vabson","year":"2025","journal-title":"Health Aff."},{"issue":"6","key":"2026082010363979400_qxag206-B13","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1377\/hlthaff.2024.01277","article-title":"Claim denials: low-income patients from disadvantaged racial and ethnic groups experienced the largest burdens","volume":"44","author":"Horn\u00fd","year":"2025","journal-title":"Health Aff."},{"key":"2026082010363979400_qxag206-B14","author":"Johns Hopkins Medicine and UnitedHealthcare: What You Need to Know"},{"key":"2026082010363979400_qxag206-B15","author":"Levinson"},{"issue":"4","key":"2026082010363979400_qxag206-B16","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.8785","article-title":"Analysis of hospital operating margins and provision of safety net services","volume":"6","author":"Gaffney","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026082010363979400_qxag206-B17","author":"Agency for Healthcare Research and Quality"},{"key":"2026082010363979400_qxag206-B18","author":"2023 QPP Public Use File: Data Dictionary"},{"issue":"5","key":"2026082010363979400_qxag206-B19","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.117.003587","article-title":"Social risk factors and performance under Medicare's value-based purchasing programs","volume":"10","author":"Joynt","year":"2017","journal-title":"Circ Cardiovasc Qual Outcomes."},{"issue":"7","key":"2026082010363979400_qxag206-B20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.23923","article-title":"Variation, overlap, and stability in defining safety net hospitals","volume":"8","author":"Chatterjee","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026082010363979400_qxag206-B21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-077797","article-title":"Comparison of prior authorization across insurers: cross sectional evidence from Medicare Advantage","volume":"384","author":"Gupta","year":"2024","journal-title":"BMJ"},{"key":"2026082010363979400_qxag206-B22","author":"AHIP 2022 Survey on Prior Authorization Practices and Gold Carding Experiences"},{"key":"2026082010363979400_qxag206-B23","author":"American Hospital Association"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag206\/70514802\/qxag206.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/8\/qxag206\/70514802\/qxag206.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/8\/qxag206\/70514802\/qxag206.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:37:34Z","timestamp":1787236654000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag206\/8753776"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":23,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag206","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,8]]},"article-number":"qxag206"}}