Palmetto GBA says more than two out of every five claims it denied under medical review in the first quarter of 2026 were due to requested records not being submitted.
 
In total, 562 claims were denied for this reason. That’s up from 334 claims denied in the previous quarter.
 
Below are the top five reasons and the percent of claims denied (along with the Q4 2025 percentages):
  1. Auto Denial – Requested Records Not Submitted: 44.3% (34.9%)
  2. No Plan of Care or Certification: 18.4% (22.1%)
  3. Information Provided Does Not Support the Medical Necessity for This Service: 12.5% (12.2%)
  4. Face-to-Face Encounter Requirements Not Met: 10.3% (17.6%)
  5. Information Provided Does Not Support the Medical Necessity for Therapy Services: 2.5% (3.4%)
See more information at palmettogba.com.