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.
Pending status
This product is in the .dev preview as a pending methodology commitment. It is not presented as a live surface until the source contract, normalization path, refresh cadence, and public-preview limits are ready.
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.
Distribution and join path
Scope: Nationwide where disclosures exist; TN/TennCare focus; Davidson County Atlas
Entity graph join: `payer_id`, `procedure_code`, `npi`, `ccn`, state regulator entity, county/market.
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.
Notify me at launch
Denial Reason Atlas is pending. Subscribe to The Branmoor Brief to be notified when the source-backed preview is ready.