Denial Cost Calculator

Estimate the work behind initial denials

Use this calculator for planning: how many cases may need follow-up, what that effort could cost and what allowance is associated with unresolved cases. Those measures are shown separately because they answer different questions.

Use one defined group of claims

Enter a monthly claim count and an initial denial rate measured on the same basis. Count a case once, rather than counting each resubmission as a new initial denial. The average allowance and rework cost should describe that same group.

Your per-case rework estimate should include staff time only once. Define what “resolved” means and the follow-up period behind the resolution assumption.

Try the monthly example

With 20,000 claims and an 8% initial denial rate, the model estimates 1,600 initial denials. At $21 of rework per claim, that is $33,600 in administrative effort. A $230 average allowance gives $368,000 associated with the group.

An assumed 48% resolution rate leaves 832 cases and $191,360 of allowance under review. The example inputs are illustrative, not industry averages. Unresolved allowance is not a confirmed loss.

Why delay is shown in days

The delay field records your timing assumption. It is not added to rework cost or converted to a financing cost; that would require a separate model.

Use the estimate in your report

Keep the assumptions beside the result so a colleague can tell whether a change came from volume, denial rate or cost per case. Compare estimated workload separately from actual money received.

Read the worked example · View the formulas · Report financial outcomes

Print the result or copy it with the inputs for your review. Changing a value marks the previous result as outdated until you calculate again.

No claim records required

The calculation runs in your browser. Use non-identifying totals, not patient information. The Ask DueMD link does not send these values.