91% of it sits with just three payers and two denial patterns.
of $4.10M billed-then-denied · 71% has a clear, documented path to recovery
You can't work Aetna and NYSIF the same way.
The recoverable dollars ranked two ways — by who's holding them and by why they were denied. Click any row to trace to the underlying claims.
The ranked plan — start at the top.
Four moves recover $1.09M. Each is a specific, documented action with a likelihood and the exact claims behind it. Work them in order.
Bulk-appeal NYSIF aged workers’-comp claims
Adjudication SLA breached on the aged >90d population. Precedent shows payment on escalation with the statutory interest demand attached.
Resubmit Aetna downcoded E/M with corrected modifiers
Claims downcoded 99214→99213 or stripped of modifier 25. Documentation supports the original level; corrected 837P resubmission is clean.
File timely-filing reconsiderations with Blue Cross
No-fault claims denied CARC 29. Proof-of-timely-submission on file for 71% — attach and reconsider.
Trigger secondary billing on PI self-pay
Personal-injury claims settled primary but never billed secondary. Liens identified; secondary payer billable now.
The diagnosis behind the gap.
Each driver ranked by dollar impact, with the claim population it traces to. This is what changed — and what the plan above is built to reverse.
Every figure shows its work — and waits for you.
The answer is only as good as its evidence. Provenance on every number, a confidence gate before anything computes, and a clean roll-up across entities.
Nothing computes until a human signs off on anything under the 0.85 gate.