OUTCOMES DASHBOARD

TRACK YOUR
WINS.

See every appeal outcome, recovery dollar, and ROI metric in one view. The numbers your CFO needs.

Period: Loading...Updated: 8:38:28 PM

DEMO DATA

UHC May 2026: PCP referral required for cardiac/vascular specialists (MA HMO)

Action Required

KEY PERFORMANCE INDICATORS

Claims Analyzed

342

+12%

Denials Identified

14.0% rate

Appeals Generated

7 pending

Win Rate

76%

+5% vs Q4

Total Recovered

$5,230,000

+34% vs Q4

Avg Time to Appeal

2.3 days

vs 30-60 industry

Denials by Payer

UnitedHealthcare18 denials

$2,100,000

78% win rate

Anthem / Elevance12 denials

$1,450,000

75% win rate

Cigna / EviCore9 denials

$890,000

71% win rate

Humana5 denials

$480,000

80% win rate

Other4 denials

$310,000

75% win rate

Denials by Procedure

CABG (33533)8 denied

82% win$1,440,000 value

TAVR (33361)7 denied

71% win$1,050,000 value

TKA (27447)9 denied

78% win$495,000 value

EVAR (34705)6 denied

67% win$570,000 value

PCI (92928)5 denied

80% win$225,000 value

Top Denial Reasons

CO-197

40%

CO-50

29%

CO-16

17%

CO-96

CO-204

Recent Activity

UHC May 2026: PCP referral required for cardiac/vascular specialists (MA HMO)

CO-197 denials up 23% MoM for cardiac surgery — possible new UHC algorithm

CABG appeal #UCSF-4891 won: $180,000 recovered (multi-pronged strategy)

Quarter-to-Date ROI Summary

Based on 41 appeals generated and 31 successful outcomes.

Total Recovered

$5,230,000

Est. Platform Cost

$12,500

ROI

418x

Annualized Projection

$20,920,000