Skip to content

Premier’s National Survey on Payment Delays and Denials

Premier is collecting data to continue to inform our advocacy on behalf of members experiencing persistent payment denials and delays by health plans. We are interested in learning more about the financial and administrative burdens that providers face when appealing or pursuing denials/delays in claims payment. Understanding the severity of the issue amongst our members will help inform the development of a data-driven advocacy strategy in Washington DC.


For the purposes of the survey, please consider the time period from January 1, 2023 to December 31, 2023. Please answer the following questions, to the best of your knowledge, by September 16, 2024. Should your organizational policies require that you submit this information in a different format, or via protected means, please contact Mason (Mason_Ingram@premierinc.com) and we will gladly work with you to meet your organization’s needs.


Ideally, the survey should be completed by the Finance or Revenue Cycle Management teams. Responses to the survey will be aggregated and anonymized.
1.During the period from January 1, 2023 to December 31, 2023, what volume of your organization’s claims were subject to pre-service approvals (e.g., prior authorization) by health plans? Please enter a percentage (0-100) in the text boxes for each insurance type.
2.During the period from January 1, 2023 to December 31, 2023, what percentage of initial claims submitted to payers were denied? Please enter a percentage (0-100) in the text boxes for each insurance type
3.Of the claims initially denied in Question 2, what percentage of denials were eventually overturned and the claims paid? Please enter a percentage (0-100) in the text boxes for each insurance type.
4.What proportion of claims that received a prior authorization were denied? Please enter a percentage (0-100) in the text boxes for each insurance type.
5.On average, how many rounds of payer review (including prior authorization, post-payment audits, etc.) does your organization undergo prior to receiving final claims payment? Please enter a number from 0-10 in the text boxes for each insurance type.
6.Does your organization track the administrative cost of pursuing denials and/or delays in claims payments?
7.If you responded “Yes” to Question 6 above, what is the administrative cost of pursing denials and/or delays in claims payments? Please enter an average dollar amount per claim in the text boxes for each insurance type.
8.What percentage of claims payments/remittances are “past due” to your organization based on the terms of your payer contracts? Please enter a percentage (0-100) in the text boxes for each insurance type
9.Did claims denials and delays worsen during period from January 1, 2023 to December 31, 2023? Please select one response per insurance type.
Worsened
Improved
No Change
Do Not Know
Medicare
Managed Medicare
Medicaid
Managed Medicaid
Managed Care and Other Commercial
Marketplace Exchanges
10.Based on your organization’s experience, is there a dollar threshold above which denials and/or delays become more prevalent? If so, please indicate your best dollar estimate(s) below.
11.Does your organization have a defined policy to determine at what point denials and/or delays count as unpaid or uncompensated care? If so, how has this affected your unpaid or uncompensated care estimates overall?
12.Based on your organization’s experience, what is the percentage of discharges to post-acute facilities (e.g., skilled nursing) that are initially denied? Please enter a percentage (0-100) in the text boxes for each insurance type.
13.Based on your organization’s experience, how do delays/denials around coverage of discharges to post-acute care affect your care planning timelines?
14.Based on your organization’s experience, for what percentage of denied claims were you asked to downgrade the DRG, in order to receive claims payment? Please enter a percentage (0-100) in the text boxes for each insurance type.
15.With regard to patients who are covered by Medicare Advantage plans, who is responsible for managing the prior authorization process and ultimately securing authorization for a covered stay in a post-acute setting (e.g., SNF, home health)?
16.Is there any additional information that you would like to share that might be helpful in our analysis?
17.Name
18.Email Address
19.Organization
20.In which states does your organization operate?
21.How many acute beds does your organization have?
22.If your organization operates across multiple states, is your experience consistent across all states?