Sample report
Sample Denial Report
Denials grouped by reason, payer and status, with the fix for each root cause. Fictional practice, illustrative numbers.
Denial Report: Sample
Fictional practice. All figures are illustrative.
Fictional practice. All figures are illustrative.
SAMPLE / DEMONSTRATION DATA. This report describes a fictional practice. It is not a real client.
1. Denials by reason
| Category | CARC examples | Count | Dollars | Share |
|---|---|---|---|---|
| Eligibility | CO-27, CO-31 | 42 | $7,980 | 31% |
| Coding | CO-4, CO-11, CO-97 | 30 | $6,150 | 22% |
| Authorization | CO-197, CO-15 | 24 | $9,840 | 18% |
| Missing information | CO-16 | 23 | $3,110 | 17% |
| Timely filing | CO-29 | 5 | $880 | 4% |
| Other | Various | 11 | $1,650 | 8% |
2. Denials by payer
| Payer type | Denial rate | Top reason |
|---|---|---|
| Commercial | 4.6% | Authorization |
| Medicare Advantage | 7.9% | Eligibility |
| Traditional Medicare | 3.1% | Coding (NCCI) |
| Medicaid managed care | 8.4% | Eligibility |
3. Appeal status
| Status | Claims | Dollars |
|---|---|---|
| Appealed, pending | 27 | $8,300 |
| Overturned and paid | 41 | $11,250 |
| Corrected and resubmitted | 52 | $6,480 |
| Written off (after review) | 6 | $540 |
Benchmarks are common industry targets, not guarantees. Results vary by practice, specialty, payer mix, claim volume, billing history and documentation.
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