Stop reporting denials. Start ending them.
Benchmark your practice's first-pass clean claim rate (95–98% HFMA target), monitor payer turnaround times, and route root-cause feedback directly to the responsible upstream departments.
Payer Behavior Scorecards
Track denial rates, average days to pay, and appeal responsiveness per payer. Cross-reference internal performance with newly published CMS-0057-F insurer disclosures.
Upstream Department Routing
Automated monthly feedback reports routed to front-desk registration (eligibility & COB errors), clinical staff (prior auth lapses), and billing (modifier NCCI edits).
Board & Sponsor Reporting
Executive-ready PDF exports designed for private equity operating partners, MSO boards, and CFOs showing total cash recovered and net margin lift.
National Payer Overturn Benchmarks (CMS-0057-F)
Compare your practice's overturn win rates against official calendar year 2025 federal compliance filings.
Major Payer Prior-Authorization Denial & Overturn Rates
| Payer Organization | PA Denial Rate | Expedited Denial Rate | Overturned on Appeal | Median Response | Operational Intelligence | Guide |
|---|---|---|---|---|---|---|
| Centene | 15% | 13% | 93% | 1.0 days | Overwhelming majority of denials overturned upon timely submission of chart notes. | Playbook |
| CVS Health (Aetna) | 8% | 11% | 89% | 1.1 days | High overturn rate when CPB (Clinical Policy Bulletins) are explicitly referenced. | Playbook |
| Elevance Health | 5% | 3% | 75% | 1.4 days | Lowest baseline PA denial rate, but responsive to peer-to-peer documentation attachments. | Playbook |
| Humana | 7% | 10% | 64% | 0.9 days | Strict Medicare Advantage guideline enforcement; fast response to online portal filings. | Playbook |
| UnitedHealth Group | 17% | 11% | 60% | 1.2 days | Highest PA denial rate among top 6 commercial carriers; high overturn on level 1 clinical re-review. | Playbook |
| Kaiser Permanente | 13% | 7% | 40% | 0.8 days | Closed HMO network rules require precise out-of-network continuity citation. | Playbook |
See what your denials are actually worth.
Send us one month of 835 remittances under a signed BAA. We'll show you exactly how many dollars are recoverable — before you pay anything.