Practice Reporting. Prepared for Rowan Bexley on Oct 7, 2026. Whole organization.

January 2026 · prove it

Denial rate, Statewide Care Program

12.75%ExplainedReconciled 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: 38
Claims a payer first decided on in the month: 298
Result: 12.75%
Filters: Primary payer only
The payer’s first decision only
Self pay left out (no payer decides on it)
Scope: Statewide Care Program

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: 13.62%
Difference (ours minus athena): -0.87 points
Tolerance: Up to 0.50 points either way
Evidence: Open the athena report athena-2026-01-denial-management (sample), sample report, opens in a new tab
Checked: Feb 4, 2026, 9:00 AM EST by Rowan Bexley
Why they differ: athena’s Denial Management report counts a claim again when its corrected resubmission is denied too. Our definition counts only the payer’s first decision on a claim. The report’s claim list shows 3 such resubmission denials for this payer this month, each adding one denial and one decided claim. Take them out and athena’s figure is ours exactly.Current explanation, written by Rowan Bexley, Feb 4, 2026, 10:00 AM EST

For your IT team

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