Tuesday · December 9, 2025 · November close
Good morning, Karen.
November denials are in — $184K, down from $211K.
Aisling has closed the books on November, clustered the denials, and drafted a prioritized worklist for billing. Below is what's worth your attention this morning.
Total denials · November
$184K
-12.8% vs October
Denial rate
11.2%
-1.4pp vs October
Forecast if actions taken
$130K
-20–30% over 90 days
First-pass approval rate
88.8%
+1.4pp
Aisling
Listening · context: November financial close
Good morning, Karen. Here's the November summary:
- $184,000 in total denials
- 11.2% denial rate
Top drivers:
November denial drivers
Authorization issues$62,000
Medical necessity$48,000
Coding mismatches$31,000
Repeat payer (Cigna BH)$28,000
I've drafted a prioritized worklist and payer-specific recommendations for your billing team below.
Key insight — preventable denials
23% of November's denials were preventable with pre-visit validation.
That's $42,320 you could have recovered up front. Workflows like automated authorization checks and real-time coding validation are already in use for clinicians like Dr. Jordan — extending them to the rest of the practice should yield a 20–30% reduction in denials over the next 90 days.
Denial drivers · November
Authorization issues
$62K34% of total
Medical necessity
$48K26% of total
Coding mismatches
$31K17% of total
Timely filing
$21K11% of total
Eligibility / coverage
$18K10% of total
Other
$4K2% of total
Prioritized worklist for billing
1
High-dollar, recoverable claims
Authorization-related · 14 claims8 days avg aging
$62,400
2
Recent denials under 14 days old
32 claims across all driversPeak recovery window
$48,700
3
Cigna behavioral health · repeat pattern
Medical necessity clusteringDocumentation fix identified
$28,100
4
Coding mismatches · CPT 9021x series
Auto-validation would have caught 19/23
$19,200
5
Stale A/R · 60+ days
11 claims · secondary appeal recommended
$14,800
Recommended actions
Automate authorization checks pre-visit
Est. reduction: $42K/mo
Real-time coding validation at note sign-off
Est. reduction: $24K/mo
Payer-specific rule review · Cigna BH
Est. reduction: $12K/mo
Payer performance
Cigna Behavioral Health
14.8% denial
+2.1pp
Aetna
9.1% denial
-0.8pp
Blue Cross Blue Shield
8.4% denial
-1.2pp
UnitedHealth
7.9% denial
-0.5pp
Medicare
5.2% denial
-0.3pp