The alert
The whole product is this message, six weeks early
Everyone in this category ships a denial dashboard. Dashboards get opened at month end. This arrives on the day the regime changed, with the payer, the code, and the number of claims already out the door under the old assumption.
D
Denial RadarAPP#eng-alerts🔴 Denial rate jumped +254%payer=Aetna, code=97110
Baseline
7.00%
Now
24.8%
Confidence
99.9%
Started
Aug 11
Practice
Outpatient PT, 4 sites
Pair
Aetna · CPT 97110
Share of claim volume
7.3%
Claims since changepoint
1,046
Likely cause · Denial rate on Aetna · CPT 97110 moved from 6.9% to roughly 24% on Aug 11 and stayed there, while the same code on other payers and other codes on Aetna did not move. Days to payment rose with it and first-pass yield fell. Appeal overturn rate more than doubled, which points at an adjudication rule change rather than a coding error on your side. Overall denial rate across all payers stayed inside its normal daily range, so nothing on the standard dashboard would show this.
- 1.Pull the Aetna remits for 97110 since Aug 11 and read the new CARC/RARC combination.
- 2.Check the appeal clock on the earliest affected claims before the window closes.
- 3.Hold or amend outbound 97110 claims to Aetna until the documentation requirement is confirmed.
AcknowledgeFalse positiveCUSUM · q < 0.0001 · BH-corrected
D
Denial RadarAPP#eng-alerts🔴 Days to payment jumped +74.3%payer=Aetna, code=97110
Baseline
25.082
Now
43.730
Confidence
99.9%
Started
Aug 11
Practice
Outpatient PT, 4 sites
Pair
Aetna · CPT 97110
Share of claim volume
7.3%
Claims since changepoint
1,046
Likely cause · Denial rate on Aetna · CPT 97110 moved from 6.9% to roughly 24% on Aug 11 and stayed there, while the same code on other payers and other codes on Aetna did not move. Days to payment rose with it and first-pass yield fell. Appeal overturn rate more than doubled, which points at an adjudication rule change rather than a coding error on your side. Overall denial rate across all payers stayed inside its normal daily range, so nothing on the standard dashboard would show this.
- 1.Pull the Aetna remits for 97110 since Aug 11 and read the new CARC/RARC combination.
- 2.Check the appeal clock on the earliest affected claims before the window closes.
- 3.Hold or amend outbound 97110 claims to Aetna until the documentation requirement is confirmed.
AcknowledgeFalse positiveCUSUM · q < 0.0001 · BH-corrected
The ordering rule
Statistics decide whether the pattern changed. The written explanation only ever describes a changepoint that already cleared FDR correction, and it stops at billing behaviour. It does not judge coding, medical necessity, or whether a given denial should be appealed. Those are the biller’s calls, made with the evidence in front of them instead of six weeks after the fact.