What Are the Two Most Common Claim Submission Errors in 2026?

The 2 most common claim submission errors are incorrect patient information and missing or invalid medical codes. These errors trigger immediate claim rejections or denials, disrupting revenue cycle management and delaying reimbursements for healthcare providers.

According to the American Medical Association (AMA), medical billing errors cost the U.S. healthcare system over $17 billion annually. Identifying and correcting these errors at the source is essential for maintaining a clean claims rate and consistent cash flow.

The following blog is a walkthrough of identifying and preventing the two most common claim submission errors in 2026.

What Are the Two Most Common Claim Submission Errors?

The 2 most common claim submission errors in medical billing are incorrect patient information and missing or invalid medical codes. Both errors are preventable and account for the majority of claim rejections across payers like Medicare, Medicaid, and private insurers.

What Is Incorrect Patient Information in Claims?

Incorrect patient information occurs when submitted claims contain mismatched, incomplete, or outdated patient demographic data. Payers cross-reference submitted data against their enrollment records. Any discrepancy triggers an automatic rejection.

Common examples of incorrect patient information include:

• Misspelled patient name
• Wrong date of birth
• Incorrect insurance ID number
• Invalid subscriber information
• Mismatched gender field

A 2022 report by Change Healthcare found that 61% of claim denials are caused by front-end errors, with patient demographic mismatches being the leading contributor.

What Specific Patient Data Fields Cause the Most Errors?

The 4 patient data fields that cause the most claim errors are name spelling, date of birth, insurance ID, and group number. These fields are verified automatically by payer systems during the adjudication process.

Errors in these fields occur during patient registration, insurance verification, or manual data entry. Even a single-character mismatch in a patient’s name can result in a rejection. Practices that rely on manual intake forms report higher error rates compared to those using electronic eligibility verification tools.

What Are Missing or Invalid Medical Codes?

Missing or invalid medical codes occur when claims are submitted with incorrect, outdated, or unsupported CPT, ICD-10, or HCPCS codes. Payers require precise code combinations to validate medical necessity and process reimbursement.

The 3 primary code types involved in claim submission errors are:

1. CPT codes cover procedure codes that describe the service provided
2. ICD-10 codes cover diagnosis codes that justify medical necessity
3. HCPCS codes cover codes for supplies, equipment, and non-physician services

How Do Incorrect CPT and ICD-10 Codes Cause Claim Denials?

Incorrect CPT and ICD-10 codes cause claim denials when the submitted diagnosis does not support the billed procedure. Payers use code-editing software to validate code pairs. Mismatched or unsupported combinations result in automatic denial.

Common coding errors include:

• Using deleted or outdated ICD-10 codes
• Submitting a CPT code without a supporting diagnosis
• Upcoding or undercoding procedures
• Missing modifiers on surgical or evaluation codes

According to CMS, improper payments due to coding errors totaled over $28.8 billion in the 2025 fiscal year.

How Do These Errors Impact Healthcare Providers?

Claim submission errors directly reduce revenue, increase administrative workload, and delay patient care decisions. Providers who do not track denial patterns face compounding revenue loss over time.

What Are the Financial Costs of Claim Submission Errors?

Claim submission errors cost healthcare providers an average of $25 per claim to rework and resubmit. For high-volume practices, this expense accumulates significantly across billing cycles.

The Medical Group Management Association (MGMA) reports that practices with denial rates above 10% experience measurable revenue shortfalls. The industry benchmark for a clean claims rate is 95% or higher. Practices below this threshold face increased accounts receivable days and reduced cash flow.

How Do Claim Errors Affect Patient Experience?

Claim errors delay patient billing, create confusion over balances owed, and reduce trust in the provider’s administrative process. Patients who receive unexpected bills due to reprocessed claims report lower satisfaction scores.

Delayed reimbursements caused by claim errors can also affect a provider’s ability to schedule follow-up care, particularly for patients dependent on insurance approvals for ongoing treatment.

What Is the Difference Between a Claim Rejection and a Denial?

A claim rejection occurs before adjudication, while a claim denial occurs after the payer has processed the claim. Understanding this distinction determines the correct resolution path.

Rejections are triggered by technical or formatting errors such as missing fields or invalid codes and can be corrected and resubmitted without a formal appeal. Denials occur after the payer reviews the claim and determines it does not meet coverage or medical necessity criteria. Resolving a denial requires supporting clinical documentation and a structured appeals process, which extends the resolution timeline significantly.

Tracking both rejection and denial patterns separately helps providers identify whether errors originate at the front end during registration or at the coding and documentation stage.

How Can Providers Prevent These Claim Submission Errors?

Providers prevent claim submission errors by implementing claim scrubbing tools, conducting regular staff training, and using technology that validates data before submission.

What Is the Role of Claim Scrubbing in Error Prevention?

Claim scrubbing is the automated process of reviewing claims for errors before submission to a payer. Scrubbing software checks for missing fields, invalid code combinations, and demographic mismatches in real time.

Practices using claim scrubbing tools report clean claim rates of 95% to 98%, compared to 80% to 85% for those relying on manual review. Clearinghouses like Availity and Waystar offer integrated scrubbing as part of their claim management platforms.

How Does Staff Training Reduce Billing Errors?

Regular billing staff training reduces claim errors by keeping coders and front-desk staff updated on payer requirements, code updates, and registration protocols. The AMA and AAPC release annual CPT and ICD-10 code updates that affect claim accuracy.

Providers should conduct training at least 2 times per year, specifically before the annual ICD-10 code update cycle in October. Front-desk staff training on insurance verification reduces demographic errors at the point of registration.

What Tools Help Reduce Claim Submission Errors?

3 tools that reduce claim submission errors are electronic health record (EHR) billing modules, clearinghouse claim scrubbers, and real-time eligibility verification systems.

EHR billing modules auto-populate patient data from registration into claims, reducing manual entry errors. Clearinghouse scrubbers validate code combinations and payer-specific requirements before transmission. Eligibility verification tools confirm active coverage, correct ID numbers, and plan details prior to service.

Conclusion

The 2 most common claim submission errors are incorrect patient information and missing or invalid medical codes. Both errors are preventable through claim scrubbing, staff training, and real-time eligibility verification. Providers who address these errors at the source maintain higher clean claim rates, reduce administrative costs, and protect revenue cycle performance.

Partnering with a professional medical billing company reduces claim submission errors, improves clean claim rates, and protects your practice’s revenue cycle. A dedicated billing team handles claim scrubbing, code validation, and denial management so your staff can focus on patient care. Contact us today to learn how our medical billing services can reduce your denial rate and streamline your reimbursement process.

FAQs

What is the most common reason for claim denial? 

The most common reason for claim denial is incorrect or mismatched patient information, including name, date of birth, and insurance ID, which prevents payer systems from matching the claim to an active policy.

What is a clean claim in medical billing? 

A clean claim is a submitted claim that contains no errors, omissions, or flags that would delay or prevent processing by the payer.

How long does a provider have to resubmit a denied claim? 

Most payers allow providers 90 to 180 days from the date of service to resubmit a corrected claim, though timely filing limits vary by payer and plan type.

What is upcoding in medical billing? 

Upcoding is the practice of submitting a billing code for a more expensive service than what was actually performed, which constitutes fraud under federal healthcare regulations.