Several payers are accusing providers of driving higher healthcare costs through aggressive coding practices.
The long-standing tension between payers and providers reared its head during recent earnings calls for some health insurers.
Elevance Health and Centene, among others, have told their investors that aggressive provider coding hampers their financial performance.
In a 2025 Q2 earnings call, Elevance Health CFO Mark Kaye stated: “We also do see a subset of providers employing more aggressive coding tactics and, in some ways, inappropriately leveraging what we think of as the independent resolution process that obviously inflates amounts.”
Asked for an update on the coding trend during a Q3 earnings call, Elevance Health CEO Gail Boudreaux said: “We are very aggressively addressing the higher coding intensity and we've seen it in pockets but have significant tools to advance that as well.”
Meanwhile, in a 2025 Q2 earnings call for Centene, CEO Sarah London attributed higher in-year documented morbidity to, at least in part, “aggressive provider coding.”
RCM Technology as a Defensive Tool
For revenue cycle leaders, investments in tools like ambient listening, agentic coding, and appeals automation are seen as a necessary defensive maneuver in response to payers’ own strategic use of technology to deny and delay payments.
“When we talk about payers, they’ve been in the AI space probably a little ahead of us as healthcare providers,” Christina Slemp, System VP of Revenue Cycle at UNC Health, said during a recent HealthLeaders webinar. “And so, I think we’re just catching up.”
UNC Health SVP and Chief Revenue Officer Stephen Rinaldi explained in a separate HealthLeaders webinar that denials are the “largest pain point” for revenue cycle leaders and that payers maintain control overutilization by “denying, delaying, or otherwise avoiding payment in some particular way.”
The AI vs. AI Arms Race
Payer condemnations of aggressive coding practices are occurring within the broader context of their ongoing technological arms race with providers. Payers use technology to prevent payment for services they deem medically unnecessary, while providers use it to ensure reimbursement that they feel is owed.
Moving forward, how the opposing sides are using technology could fundamentally shift power balances in contract negotiations.
“I think AI on the healthcare side is going to drive our contracting,” Slemp said. “We have more data, and data is power.”
The aggressive coding accusations illuminate the longstanding tension with providers that drive inefficiencies on both sides. While new technologies have the potential to reduce administrative burden for both parties, revenue cycle leaders mostly seem unimpressed by the degree to which that has occurred so far.
For now, revenue cycle technology investments are a necessary and justified response to protect revenue – not by inflating claims, but by ensuring that accurate documentation demonstrates that reimbursement is earned and deserved.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Payer accusations of "aggressive provider coding" are a response to provider investments in AI used to fight denials and protect revenue.
Denials are the "largest pain point" in the revenue cycle, driven by payer strategies to control utilization by delaying or avoiding payment.
Continued investments in technology are leading to an accumulation of data that could fundamentally shift the way contract negotiations occur.