Denial Management & Root-Cause Intelligence

Lakeview Health Partners · 420-bed Regional System · Current Period: Week 13 (Latest)

First-Pass Denial Rate

7.4%

↓1.8% vs wk 6 spike

Overturn Rate

52.3%

↓3.1% QoQ

Preventable Denial %

41.2%

Target: 35%

Avg Days in Rework

18.6

↑2.1d vs prior

Write-Off Rate

2.8%

↓0.4% MoM

Net Recovery Yield

68.4%

+1.9% QoQ

Denial Root-Cause Distribution by CARC Code

Preventable Denial Rate — 13-Week Rolling

Denial Rate by Payer Tier

Overturn Rate by Appeal Tier

Days in Denial Rework Distribution

Payer Contract Compliance Score

Auth Rate

Timely File

COB Accuracy

Med Necessity

Coding Valid

Overall

Anthem

72%

81%

94%

68%

85%

80%

UnitedHealthcare

84%

92%

87%

79%

91%

87%

Cigna

91%

95%

93%

88%

94%

92%

Aetna

93%

96%

91%

90%

95%

93%

BCBS

96%

97%

95%

92%

96%

95%

≥90% Compliant

80-89% Warning

<80% Critical

CARC Code Pareto — Top 8

Write-Off Rate by Service Line

Coder-Level Denial Performance

Coder ID	Specialty	Clean Claim %	Denial Rate	Avg Denial $	Top Denial Code	Status
C-047	Cardiology	81.2%	18.8%	$1,842	CARC 96	Action Required
C-023	Orthopedics	92.4%	7.6%	$1,124	CARC 4	On Target
C-091	General Surgery	94.1%	5.9%	$987	CARC 29	On Target
C-112	Neurology	88.7%	11.3%	$1,453	CARC 97	Monitor
C-065	Oncology	95.3%	4.7%	$2,145	CARC 22	On Target
C-158	Emergency Med	86.2%	13.8%	$876	CARC 29	Monitor
C-034	Radiology	96.8%	3.2%	$564	CARC 4	On Target
C-201	Gastroenterology	91.5%	8.5%	$1,267	CARC 96	On Target