ENTERPRISE ROI CALCULATOR
Discover how much revenue your health system is losing to preventable denials — and what you could recover with intelligent denial management.
Based on CMS data and analysis of 200+ payer denial patterns
Your Denial Revenue Opportunity
Your results are based on CMS Healthcare Data System analysis and 200+ payer behavior patterns
- CMS: Healthcare Data System denial rates by payer
- CMS: Hospital Cost Report claim volumes
- Third-party analysis: External review success rates (77% for surgical appeals)
- Insider data: 20 years of health system experience
- Payer intelligence: 200+ denial interactions across 12 major payers
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We'll customize this ROI model to your payer mix, specialty focus, and historical denial patterns. No obligation, no sales call.
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The calculator combines your claim volume, denial rate, average denied claim value, and current appeal rate to estimate annual revenue at risk. It then projects recovery using CoverageUnlocked's 76% win rate (compared to the current 45% national average from professional appeals) and 80% appeal rate (compared to <1% current industry average). The result: net additional recovery and 3-year cumulative impact.
The calculator is based on: (1) CMS Healthcare Data System showing denial rates by payer and plan type, (2) CMS Hospital Cost Report for claim volumes and revenue figures, (3) 20+ years of health system insider data from managing 200+ million claims, (4) third-party analysis of external review success rates (77% for surgical appeals), and (5) real behavior patterns from 200+ denial interactions across UHC, Anthem, Aetna, Cigna, Humana, Centene, Kaiser, Molina, and regional payers.
CMS data shows the average commercial health plan denial rate is 19% across all claim types. However, this varies significantly by payer: UnitedHealth 10-15%, Anthem 18-22%, Aetna 20-25%, Cigna 17-21%. Surgical denials run higher at 25-35%. The 19% default reflects the national mean; adjust upward if your specialty mix is surgical-heavy or your payer mix skews toward higher-denial plans.
The 76% win rate reflects CoverageUnlocked's platform accuracy using predictive AI analysis (defeating payer decision logic), payer-specific intelligence, regulatory leverage points, and clinical evidence frameworks. It's grounded in third-party analysis of professional denial appeal success rates (78% for human-staffed services) and CMS external review data showing 77% success on surgical appeals. CoverageUnlocked's AI-native approach aims to match or exceed these benchmarks through automated evidence synthesis and payer-specific tactical insights.
Yes. Enter your email below and we'll send you a detailed ROI analysis customized to your claims data, payer mix, and specialty focus. This goes beyond the calculator and includes: your actual denial patterns (if you have data), payer-specific recovery recommendations, timing and effort projections, and pricing options. No obligation, no aggressive sales follow-up.