Denials
What was withheld, why, and how much is worth chasing.
Denials
12,891
Money withheld
Hard denials
10,394
CLP02 = 4
Denied
5,041,378.78
Total exposure
Recoverable
3,771,771.54
Realistically collectable
Net of rework
3,484,277.54
Less the cost to work
Below cost
255
Not worth working
By root cause — what went wrong
| Root cause | Denials | Denied | Net recoverable |
|---|---|---|---|
| ELIGIBILITY | 5,895 | 2,587,515.33 | 2,404,770.33 |
| TIMELY_FILING | 1,345 | 597,375.62 | 0.00 |
| DUPLICATE | 1,190 | 536,207.40 | 0.00 |
| AUTHORIZATION | 1,177 | 406,422.80 | 369,935.80 |
| BILLING_ERROR | 929 | 326,588.34 | 297,789.34 |
| CODING | 658 | 234,070.01 | 213,672.01 |
| NON_COVERED | 736 | 136,024.22 | 0.00 |
| MEDICAL_NECESSITY | 712 | 129,226.52 | 117,880.52 |
| COB | 249 | 87,948.54 | 80,229.54 |
| Total | 12,891 | 5,041,378.78 | 3,484,277.54 |