Payer Scorecard 2026: Practices cite low pay, denials and prior auth surge

Physician practices are juggling more payers, more prior authorizations and stubbornly low satisfaction with the basics of doing business with insurers, according to the 2026 Physicians Practice Payer Scorecard.

Payment problems rise to the top

The survey points to a familiar pressure point for practice leaders: payment. When respondents were asked to name the biggest challenges with their largest payer’s plans, “low reimbursement from the payer” was the top choice at 52% after results were normalized. Claim denials ranked second at 24%, followed by “getting paid” at 15%.

Prior authorization volume keeps climbing

The administrative load is rising, too. More than eight in 10 respondents, 84%, said their practice completed more prior authorizations in the past year. Just 2% said prior authorization volume decreased.

Payer mix is sprawling for many practices

Many practices are managing a broad payer roster. The most common response to the payer count question was “more than 20 payers,” selected by 33% of respondents. Another 38.5% said they accept between eight and 20 payers. Only 14% reported accepting seven or fewer.

Commercial insurance remains the backbone of most payer mixes in the results. About 64% of respondents said their practice accepts commercial plans, compared with 22% for Medicare and 10% for Medicaid.

Contract negotiations are limited

On contract negotiations, the survey suggests many practices feel constrained. About 34% said their practice does not negotiate payer contracts. Among those that do, responsibility was split across roles, with 25% pointing to practice managers and 21% to physicians. Administrators, billing managers and outside consultants accounted for smaller shares.

Customer service and payments earn the lowest ratings

If there is a bright spot, it is that practices rated patient-facing information less harshly than other payer functions. The overall report card still leans negative, especially for services that directly affect revenue cycle performance.

Customer service drew the steepest criticism. About 65% rated their largest payer “poor” on topics such as response time, time on hold and willingness to negotiate, producing a weighted average score of 1.6 on a five-point scale. Payments and reimbursement performance scored nearly as low, with 53% rating it “poor” and a weighted average of 1.7. Practice communication was similarly bleak, with 52% rating it “poor” and a weighted average of 1.7. Patient information performed better by comparison, but still saw 38.5% rating it “poor,” with a weighted average of 2.0.

AI is not a relationship fix, at least for now

The survey also hints at why many practice leaders are cautious about new technology as a cure for payer friction. Only 18% of respondents said their practice uses artificial intelligence (AI)-integrated coding or documentation software. When asked how AI tools have affected payer relationships, none said AI made relations better. About 70% reported no change, whereas 30% said AI made payer relations worse.

The themes are consistent in open-ended responses

Open-ended responses repeatedly returned to the same themes: low reimbursement, denials and downcoding, recoupments and the difficulty of reaching a person who can resolve an issue. Several also pointed to inconsistent rules and delayed payments as a continuing drag on operations.

Taken together, the scorecard reads like a snapshot of what many practice administrators report day to day. Revenue cycle challenges do not come from a single policy change. They come from the cumulative weight of denials, prior authorization requirements and inconsistent communication, layered on top of payer mixes that can stretch into the dozens.