Authorization denials account for 38% of denied charges and all of the recent increase. 71% of this category is historically recoverable on appeal.
Open denial investigationDenial rate trend
Daily rate, last 20 days. Anomaly begins Aug 13.
Denial categories
Share of denied charges and period-over-period change.
Authorization / pre-certification
38%$92K+48%
Eligibility / coverage
19%$34K+6%
Medical necessity
16%$28K+11%
Coding / bundling
14%$19K-3%
Timely filing
8%$8K-9%
Other
5%$3Kflat
Contract variance
Underpayments detected against contracted fee schedules.
Allowed amounts fell 6.2% below the contracted rate for a single imaging code family across four consecutive remittance batches. Recommended next step: submit a consolidated reconsideration package with the contract exhibit attached.