In today’s healthcare landscape, one challenge continues to dominate revenue cycle conversations: denials. From rising payer scrutiny to inconsistent documentation, the cost and complexity of managing denied claims has grown into a multibillion-dollar problem and a daily frustration for health systems nationwide.
Providers spend an estimated $20 billion annually on claims adjudication, with each denied claim costing on average $55 to rework. According to a 2025 National Provider Survey, even though nearly 70% of denials are ultimately overturned, it often takes three review cycles and 45–60 days per cycle to reach resolution—trapping revenue and labor in a reactive system.
For health systems of any size, the burden of managing denials is significant. Many maintain teams focused solely on appealing denials, diverting attention from proactive denial prevention and patient-facing revenue activities that enhance the financial experience before care begins. Without tools that identify root causes or predict high-risk claims, recoverable revenue is often written off.
By focusing on coding quality and payer-level insight, CodaMetrix enables health systems to shift from reactive rework to proactive prevention — helping to capture revenue before it’s ever denied.
Payers are applying increasingly granular criteria to justify medical necessity and documentation alignment. Yet, most EHR-based reporting tools don’t provide the level of insight needed to respond strategically. Denials may be flagged, but organizations often can’t connect trends to coding, documentation, or automation gaps—leaving millions of dollars on the table.
Traditional denial management is labor-intensive and slow. Teams spend countless hours performing manual chart reviews, assembling clinical justification, and navigating payer-specific appeals. The process is reactive by design — addressing the symptom rather than the underlying data quality issues at play. That’s where CodaMetrix takes a uniquely different approach.
CMX Insights™, CodaMetrix’s business analytics suite, delivers visibility that extends beyond what’s available in most EHRs—enabling health systems to benchmark automation rates, coding quality, and denial trends across codes, providers, and payers, while comparing performance against peer organizations. With visibility into peer performance trends, CMX Insights™ equips leaders to take strategic action—improving revenue cycle efficiency, financial outcomes, and the overall patient financial journey.
This level of intelligence helps identify payer-specific denial drivers and recurring documentation issues, transforming what was once a revenue drain into a data-informed improvement opportunity. Teams can now pinpoint high-risk CPT–diagnosis pairs, take targeted action, and educate providers on documentation best practices.
The most effective way to manage denials is to stop them before they start. CodaMetrix helps organizations get ahead of the problem by embedding quality into the coding process and empowering teams with actionable data.
Customers using CMX CARE™ report:
The result is a measurable shift from reactive revenue recovery to proactive revenue protection—a shift OHSU has experienced firsthand.
Explore our case study to learn how OHSU reduced coding-related denials by 70% with CMX CARE™, helping ease backlogs, alleviate coder burnout, redeploy talent to support other system-wide priorities, and accelerate cash flow by getting claims paid faster.
Learn how CMX Insights™ and CMX CARE™ can give your health system the tools to turn denials data into actionable revenue recovery.
