Revenue Cycle KPI Dashboard

Claims Denial & Rejection Intelligence · 13-Week Rolling Window Ending March 2025

Goal: Reduce payer-specific denial rate from 11.2% to <8% within 90 days · Recover $1.8M in denied AR by Q1 end

Overall Denial Rate
11.2%
+1.8% vs prior 13w
First-Pass Resolution Rate
76.4%
+3.2%
Denial Overturn Rate
62.8%
+1.5%
Avg Days Denied AR
42.3
+5.1 days
Write-Off Rate
4.7%
+0.9%
Net Collection Rate
94.2%
-1.3%
Denial Rate Trend by Payer Tier (13 Weeks)
Denial by Reason Code
First-Pass Resolution by Facility
Payer Performance Heat Map — Week-over-Week Denial Rate %
Payer
W1
W2
W3
W4
W5
W6
W7
W8
W9
W10
W11
W12
W13
UHC Medicare Adv
6.1
6.3
5.9
6.5
6.8
7.2
14.3
13.8
12.9
11.6
10.8
10.2
9.7
Anthem BCBS
8.2
8.5
9.1
8.8
9.3
9.6
10.1
9.9
10.4
10.7
11.2
11.8
12.1
Aetna Commercial
7.4
7.1
7.6
7.3
7.9
8.2
8.5
8.7
8.3
8.1
7.8
7.5
7.2
Medicare FFS
4.2
4.5
4.3
4.7
4.4
4.8
4.6
4.9
5.1
4.8
5.0
5.3
5.2
Medicaid Managed
13.2
13.8
14.1
13.6
14.5
15.2
14.8
15.6
16.1
15.9
16.4
17.0
16.7
Clinical Denial Rate by Service Line
Authorization Denial by Department
Top Denial Detail Drill-Down (Current Week)
Payer Denial Reason DRG / CPT Claims $ Denied Avg Age Overturn % Status
UHC Medicare Adv Prior Auth Missing 93000 (ECG) 124 $18,640 38d 71% In Progress
Anthem BCBS Medical Necessity DRG 470 (Hip Replacement) 18 $247,500 52d 58% Escalated
Medicaid Managed Eligibility/Coverage 99213 (Office Visit) 87 $9,135 61d 34% At Risk
Aetna Commercial Coding Error DRG 291 (Heart Failure) 15 $82,350 29d 89% Resolved
UHC Medicare Adv Timely Filing 76856 (Ultrasound) 42 $12,180 94d 12% Write-Off
Medicare FFS Duplicate Claim 99232 (Hospital Care) 31 $5,890 22d 95% Resolved
Anthem BCBS Prior Auth Missing 73721 (MRI Knee) 56 $31,920 44d 68% In Progress
Medicaid Managed Non-Covered Service DRG 194 (Sepsis) 9 $68,400 47d 41% Under Review
Rework Cost vs Recovery Analysis
Net Collection Rate Trend (13 Weeks)
Top 5 Denial Drivers by $ Impact (YTD)
Quick Actions
UHC Prior Auth Workflow
124 claims pending documentation
Anthem Appeals Batch
18 DRG 470 claims ready to submit
Medicaid Eligibility Check
87 claims requiring verification
Coding Education
Schedule DRG 470 documentation training