Actual denial rates by CPT code, payer, and state — cross-referenced with overturn rates on appeal. The product that makes payer-published guidance look like marketing.
What it is
Denial Reason Atlas is the concrete, shipping v1 of Branmoor's revenue-cycle line. The product answers a single question for any (CPT × payer × state) triple: what percentage of claims for this code, with this payer, in this state, are denied — and of the denied claims, what is the modal denial reason code, and what fraction are overturned on first-level appeal?
Nobody publishes this. Payers don't disclose denial rates by code; hospitals collect denial reason codes in the 835 transactions but don't share them publicly. The signal becomes visible only by cross-referencing state-mandated denial-rate disclosures (in states that require them), state insurance department complaint and appeal data, the federal No Surprises Act IDR portal data, and Transparency in Coverage allowed-amount files. Branmoor assembles the cross-reference.
The buyer is the RCM director who today loses appeals she should win because she doesn't know which arguments work against which payer. Knowing that a specific carrier denies orthopedic code 27485 at 4x the rate of a peer carrier and gets overturned 71% of the time on first-level appeal changes which denials she works first and how she works them. Sold under named institutional license.
Primary data sources
- State-mandated denial-rate disclosures — Aggregate denial rates by payer (where required: e.g., California, New York, Colorado, Washington)
- CMS Transparency in Coverage allowed-amount files — Out-of-network allowed amount records, payer-level coverage signal
- Federal No Surprises Act IDR Public Use Files — Outcome of independent dispute resolution by payer and service
- State insurance department complaint data — Consumer-filed appeal data, sometimes with outcome
- CMS Marketplace appeals data — ACA plan appeal outcomes by issuer
Buyers
- Hospital revenue-cycle directors
- Physician practice billing leadership
- RCM service providers (R1, Conifer, Ensemble, Optum360, etc.)
- Healthcare M&A diligence teams pricing target RCM performance
Methodology
Coverage is uneven by state — states with disclosure mandates have richer underlying data. Every cell carries a confidence band reflecting the underlying sample. Source documents are linked.
Inquire about access
Denial Reason Atlas is sold under named institutional license. Pricing is scoped per engagement. Reach out with the institutional context (organization, role, intended use) and we'll route a relevant scope of work.