Payer-related issues are currently contributing to 43% of identified revenue risk, concentrated in two plans.
Meridian Health Plan drives authorization denials; Cascade Benefit Alliance drives adjudication delay.
Ranked payer performance
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Prior-authorization requirements expanded for advanced imaging and pain management procedures effective Aug 12. Remit code 197 volume tripled within seven days.
Adjudication time moved from 25 to 34 days, extending AR without a corresponding denial increase. Contract variance also detected on 214 imaging claims.
Electronic remittance adoption completed in July; first-pass payment rate is now the portfolio high.
Denials concentrated in cardiology diagnostics; documentation requests up 16% quarter over quarter.
Comparison
Denial rate and average adjudication time by payer.