Practice Reporting. Prepared for Rowan Bexley on Oct 7, 2026. Whole organization.
September 2026 · prove it
Denial rate, Statewide Care Program
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
- 32
- Claims a payer first decided on in the month
- 300
- Result
- 10.67%
- Filters
- Primary payer only
- The payer’s first decision only
- Self pay left out (no payer decides on it)
- Scope
- Statewide Care Program
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
- 11.55%
- Difference (ours minus athena)
- -0.88 points
- Tolerance
- Up to 0.50 points either way
- Evidence
- Open the athena report athena-2026-09-denial-management (sample), sample report, opens in a new tab
- Checked
- Oct 4, 2026, 10:00 AM EDT by Rowan Bexley
- Why they differ
- Not explained yet. This blocks publishing.
Record athena’s figure
Type the figure exactly as the athena report shows it. The status updates as soon as you save.
Explain the difference
Say what differs and how you checked. Once saved, it appears above as the current explanation.
Before you save, check athena’s figure with your own eyes: open the athena report.
The run behind it
- Source
- Demo data
- Pulled from athena
- Oct 3, 2026, 6:00 AM EDT
- Records counted
- 43,050 claims, 1,436 appointments
- Internal checks
- All 11 passed
For your IT team
rpt-pipeline 1.1.0.