Analytics
Approval trends, denial intelligence, and payer performance — last 6 months
Approval Rate
67%
Approved / decided
+4pts vs Q3
Avg. Turnaround
5d
Days to decision
−1.2d vs last month
Cases Denied
2
17% of total
−2 vs last month
Appeal Win Rate
67%
Overturned on first appeal
+8pts this quarter
Approval Rate Trend
Monthly case outcomes over the last 6 months
Top Denial Reasons
Distribution of denial cause codes — last 6 months
Medical Necessity
34 cases41%
Out-of-Network
21 cases25%
Incomplete Documentation
17 cases20%
Benefit Exclusion
7 cases8%
Duplicate Request
5 cases6%
Payer Performance Comparison
Approval rate and average days to decision by payer
Payer Detail Table
| Payer | Volume (6mo) | Approval Rate | Avg. Days to Decision | Performance |
|---|---|---|---|---|
| BlueCross BlueShield | 31 | 88% | 3.2d | |
| Aetna | 24 | 79% | 5.1d | |
| United Healthcare | 28 | 84% | 4d | |
| Cigna | 19 | 72% | 6.3d | |
| Humana | 16 | 91% | 2.8d | |
| Medicare Advantage | 22 | 85% | 4.5d |