Practice Reporting. Prepared for Rowan Bexley on Oct 7, 2026. Whole organization.
May 2026 · prove it
Denial rate, Silver Creek Health Plan
6.50%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
- 24
- Claims a payer first decided on in the month
- 369
- Result
- 6.50%
- Filters
- Primary payer only
- The payer’s first decision only
- Self pay left out (no payer decides on it)
- Scope
- Silver Creek Health Plan
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
- 6.50%
- Difference (ours minus athena)
- None
- Tolerance
- Up to 0.50 points either way
- Evidence
- Open the athena report athena-2026-05-denial-management (sample), sample report, opens in a new tab
- Checked
- Jun 4, 2026, 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
- Jun 3, 2026, 6:00 AM EDT
- Records counted
- 43,021 claims, 1,363 appointments
- Internal checks
- All 11 passed
For your IT team
Software version
rpt-pipeline 1.1.0.