Claimmender
Denial Recovery Scorecard
Demo Outpatient Therapy Group, PLLC · January – June 2026
Prepared Aug 20, 2026
The headline
2,149 claims analyzed · $1,241,913 billed · initial denial exposure 10.6%
$132,137
Denied / adjusted
$13,044
Set aside — non-appealable or pending review
Where the money is
| Pattern | Code | Lines | Denied $ |
|---|
| Missing/invalid claim info — correctable, resubmittable | CO-16 | 87 | $32,016 |
| No prior authorization on file — appealable where auth exists | CO-197 | 59 | $21,144 |
| Timely-filing denial — appealable with submission proof | CO-29 | 39 | $12,661 |
| Units denied as excessive — often split-by-date fixable | CO-151 | 37 | $11,775 |
| 'Not medically necessary' — appealable with documentation | CO-50 | 29 | $9,768 |
| Bundled into another service — appealable with correct modifier | CO-97 | 28 | $9,345 |
| non-covered charge — check plan/policy first | CO-96 | 22 | $8,336 |
| Flagged duplicate — verify & contest where distinct | CO-18 | 19 | $7,400 |
Recovery plan if you engage us
| Workstream | Denied $ | Est. recoverable* |
|---|
| FIX & RESUBMIT | $63,235 | $37,941 |
| APPEAL | $55,858 | $22,343 |
By payer
| Payer | Denied $ | Denial rate |
|---|
| SUMMIT MUTUAL INSURANCE | $46,210 | 14.1% |
| MERIDIAN HEALTH PLAN | $45,572 | 10.8% |
| LONE STAR HEALTH | $22,535 | 7.5% |
| PIONEER BENEFIT ADMINISTRATORS | $17,820 | 9.4% |
What would your practice's numbers look like?Send 6 months of remittance files — about three clicks in your billing software — and get your own scorecard within one business day. Free, yours to keep. Recovery is contingency-only: no fee unless money posts to your accounts.
Get your free denial audit *Estimates apply conservative industry recovery rates (60% on correctable resubmissions,
40% on appealable denials) to your file's actual denial mix — they are estimates, not a guarantee.
Recoveries post to your accounts on your own remittances; Claimmender's fee applies only to posted
recoveries. Fix-&-resubmit items typically pay in 2–4 weeks; appeals in 30–90 days.
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