Survey: Resolving payer relations is a top priority for healthcare providers

Guidehouse survey identifies payer-provider disconnect as a major source of revenue cycle bottlenecks

MCLEAN, Va., April 7, 2026 /PRNewswire/ -- A majority of providers (88%) say disagreements over claims are preventing their organizations from getting paid on time and in full, according to a recent survey conducted by the Healthcare Financial Management Association (HFMA) and analyzed by Guidehouse, a global professional services firm serving the commercial and government sectors.

These findings and more are featured in Guidehouse's 2026 Revenue Cycle Management Trends report, which offers insights into leaders' most pressing revenue cycle challenges and the investments they're making to optimize performance and streamline cash flow.

"As AI continues to mature, providers will benefit from access to intelligent revenue cycle platforms that power and scale their operations. But these technologies still need sound governance and human oversight," said Andrew Hancock, Partner and Payer/Provider Financial Solutions Leader. "Our findings reinforce the need for health system leaders to invest in payer strategy and contract management to find common ground with health plans and reduce friction that slows reimbursement."

Leaders cited a number of shifts in behavior impacting their revenue cycle performance:

• Increase in denials (81%)
• Increase in prior authorization delays (74%)
• Increase in unclear or vague denial reasons or underpayments (73%)
• Excessive information requests (69%)
• Reduced reimbursement rates (41%)

While the survey showed a wide distribution of final denial rates, 20% of respondents reported a denial rate of over 5%, compared to just 12% the year before. This rise mirrors broader industry reporting and reflects a trend that providers say is threatening their ability to plan for revenue.

Many providers are looking to AI, automation, and managed services to streamline revenue cycle processes. However, nearly 60% of executives said they haven't yet implemented any AI or automation in their revenue cycle operations. Thirty-nine percent said they're implementing point solutions and just 2% said they've fully or mostly integrated these technologies across their RCM operations.

Struggling with workforce shortages and seeking external expertise, most providers (66%) are outsourcing all or part of their revenue cycle to a managed services vendor, according to the survey. Organizations taking a modular approach are most focused on functions that improve reimbursement speed and accuracy.

"Our managed services team is on the frontlines of the revenue cycle, helping the nation's leading health systems get paid faster and in full," said Ian Stewart, Partner and Health Managed Services Leader. "This data reflects what we're seeing across the country—a need for transparency, clarity, and consistency in how payers and providers work together in the revenue cycle. We're investing in platform capabilities that help teams move quickly and deliver end-to-end visibility."

Guidehouse's Health segment serves providers, government agencies, life sciences companies, payers, and other healthcare organizations. With 14 Best in KLAS^® awards, the firm's revenue cycle advisory, technology, and managed services experts bring a proven track record of helping providers combat payer challenges, reduce denials, eliminate staffing issues, improve physician satisfaction, and optimize operating costs.

About Guidehouse

Guidehouse is a global AI-led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future. guidehouse.com 

Media Contact: 
Guidehouse
Cecile Fradkin
[email protected]

SOURCE Guidehouse