TC
TeddyCare ClaimIQ
INTERNAL
Rachel Adams
Admin
RA

Platform Analytics

February 2025

Total Claims Processed
10
Feb 1-28, 2025
Clean Claim Rate
100%
All claims submitted without rejection
Total Denials Received
6
60% initial denial rate
Appeals Win Rate
83%
5 of 6 overturned
Revenue Recovered
$7,877
Through appeals process

Claims by Outcome

Paid on First Submission
4
Denied → Overturned on Appeal
5
Denied → Upheld
1

Recovery by Payer

Dollar amounts represent total revenue recovered through appeals

Denial Categories

Medical Necessity3/3 overturned (100%)
Documentation/Technical2/2 overturned (100%)
Coverage/Eligibility0/1 overturned (0%)
Key Insight
Medical necessity and documentation denials achieve 100% overturn rate through proper clinical evidence and payer communication.

Operational Metrics

Avg Turnaround (Coding)
1.2 days
Avg Turnaround (Appeals)
4.2 days
Senior Review Required
2
20% of cases
Total Call Logs
6
Payer interactions
Documents Processed
34
Clinical notes, EOBs, denial letters

Provider Summary

ProviderClaimsPaidDeniedAppealedRecovered
Sunshine Family Medicine6244$577
Riverside General Hospital4222$7,300
Total10466$7,877
Pilot period Feb 2025. Synthetic data.