Practice Reporting. Prepared for Rowan Bexley on Oct 7, 2026. Whole organization.
September 2025 · prove it
Denial rate, Northwind Mutual Benefit
7.98%MatchedReconciled with athena
What share of claims did each payer deny the first time?
How the number is made
Definition version 1, in force since Aug 3, 2025.
- Formula
- Claims a payer denied the first time it decided on them, divided by all claims a payer first decided on in the month. Resubmissions are not counted again.
- Claims denied the first time a payer decided on them
- 19
- Claims a payer first decided on in the month
- 238
- Result
- 7.98%
- Filters
- Primary payer only
- The payer’s first decision only
- Self pay left out (no payer decides on it)
- Scope
- Northwind Mutual Benefit
Checked against athena
The athena report to run, what it showed, and how far apart the two are.
- athena report
- athenaOne Denial Management report, first-pass view, grouped by primary payer
- athena’s figure
- 7.98%
- Difference (ours minus athena)
- None
- Tolerance
- Up to 0.50 points either way
- Evidence
- Open the athena report athena-2025-09-denial-management (sample), sample report, opens in a new tab
- Checked
- Oct 4, 2025, 10:00 AM EDT by Rowan Bexley
- Why they differ
- No explanation needed: the figures match or sit inside the tolerance.
The run behind it
- Source
- Demo data
- Pulled from athena
- Oct 3, 2025, 6:00 AM EDT
- Records counted
- 42,974 claims, 1,436 appointments
- Internal checks
- All 11 passed
For your IT team
Software version
rpt-pipeline 1.1.0.