CORPUS OVERVIEW
Precedent-based denial intelligence — behavioral health RCM
N=89 PRECEDENTS
Total Precedents
89
Across 6 payers
Weighted Overturn Rate
61.8%
Appeals with favorable outcome
Denial Categories
6
Tracked in corpus
Active Playbooks
4
PA-001, ENR-001, COV-001, DOC-001
PAYER DOSSIERS
UnitedHealthcare
AGGRESSIVE
77.8%
Overturn Rate
18
Precedents (N)
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BCBS
AGGRESSIVE
70.0%
Overturn Rate
20
Precedents (N)
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Magellan Health
MODERATE
55.6%
Overturn Rate
9
Precedents (N)
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Cigna
MODERATE
52.9%
Overturn Rate
17
Precedents (N)
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Anthem
CONSERVATIVE
46.7%
Overturn Rate
15
Precedents (N)
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Optum
CONSERVATIVE
30.0%
Overturn Rate
10
Precedents (N)
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DENIAL CATEGORY OVERTURN RATES
By Category — All Payers
Sorted by overturn rate (desc)
| Denial Category | Overturn Rate | N (Precedents) | Confidence |
|---|---|---|---|
| Prior Auth Missing | 80.0% | N=15 | |
| Coverage Gap | 62.5% | N=16 | |
| Enrollment Issue | 61.9% | N=21 | |
| Documentation Gap | 53.8% | N=13 | |
| Medical Necessity THIN DATA | 50.0% | N=4 | |
| Coding Error THIN DATA | 50.0% | N=2 |
CORPUS DISTRIBUTION HEATMAP
Precedent Density by Category
Intensity = N / 21 (max in corpus)
Enrollment Issue
21
61.9% overturn
Coverage Gap
16
62.5% overturn
Prior Auth Missing
15
80.0% overturn
Documentation Gap
13
53.8% overturn
Medical Necessity THIN
4
50.0% overturn
Coding Error THIN
2
50.0% overturn
TOOLS & RESOURCES
Appeal Playbooks
4 structured playbooks — PA-001, ENR-001, COV-001, DOC-001 — with step-by-step appeal tactics and required documentation.
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Pattern Analysis
13 new denial knowledge base patterns detected (2 sweeps) — including NQTL Parity, ERISA Procedural Failure, Step Therapy NQTL, Improvement Standard Misapplication, and Pediatric Network Disparity.
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Platform Architecture
Corpus storage, versioning, and Registry API — 15 read-only endpoints for payer intelligence and denial pattern data.
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