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Pick one payer and one denial class. We'll work that cohort and measure overturn, cash and cost per claim against your own baseline, so you know which denials are worth fighting before you commit to more.
TSI’s Denials Economics Sprint takes one payer and one denial class, sets claim-value bands and a baseline, and works that cohort. It reports overturn, paid yield, cash, time, human effort and cost per claim, plus the break-even point for each claim-value band, below which an appeal loses money, and the case for expanding. Cohort design takes about 30 days, then 60 to 120 days of measured work: about 3 to 5 months, plus the readout. The Sprint is free and commits you to nothing.
Every appeal costs staff time, and some cost more than the claim will ever pay. Without cohort-level numbers, teams tend to work too many low-value denials and write off ones they could have won.
The Sprint answers one narrow question with evidence: on this payer and this denial class, is working the denial worth it, and at what claim value does it stop paying?
One payer, one denial class, claim-value bands and a baseline built from your own history.
TSI’s appeals team works the cohort while the Sprint runs, inside your current workflow.
Overturn rate (by claim count, within the band), paid yield (cash received as a share of the dollars on overturned claims), cash collected, days to payment, staff time per claim and cost per claim, against your baseline.
For each claim-value band, the point where the expected recovery (denied amount times overturn rate times paid yield) equals the cost to work the appeal (TSI’s fee plus your staff time on the appeal). Below it, appeals on this payer and denial class lose money.
A written readout on whether to extend to more payers or denial classes, or to stop.
Results vary by payer mix and client program.
12 months of remittance and denial data for the chosen payer, with denial reason codes and claim values, plus read access to the claims and documents the appeals team needs. Plan on a kickoff, a check-in every 2 weeks and the readout.
About 3 to 5 months, plus the readout: about 30 days to design the cohort and baseline, then 60 to 120 days of measured work, depending on how quickly the payer responds. The readout follows the measured window.
A denial analytics lead designs the cohort and baseline. TSI's appeals team works the claims. A client success lead runs the check-ins and the readout.
A business associate agreement is signed before any patient information moves. Files travel by encrypted SFTP or VPN, are used only for the Sprint, and are returned or destroyed at the end, with written confirmation.
Free, with no obligation. The Sprint commits you to nothing beyond its own scope. Expanding is a separate agreement with its own terms and fees, made on the numbers the Sprint produces.
Pick one payer and one denial class and split its denials into claim-value bands. You'll see which bands pay back the cost of an appeal and where break-even sits.
Check these numbers
Your result
Fill in your numbers, or use the example, and your result appears here.
Overturn rate counts claims. Paid yield counts dollars, on the claims that were overturned. Each is applied once, so expected cash per appeal is claim value × overturn rate × paid yield, less any vendor share.
These are averages. A band below break-even can still hold individual claims worth working.
Open the full denial economics calculator, or check one claim with the appeal break-even calculator.
Tell us which payer and denial class you want measured. A TSI specialist follows up by email.
Are you a patient with a TSI account? Use the Consumer Support Hub.
Yes. The Sprint isolates one payer and one denial class, so it can run inside your current setup without moving the rest of your denials.
One with enough volume to measure and claim values that make the economics matter. The intake call helps you choose.
Nothing. The Sprint is free. Any work after it, such as expanding to more payers or denial classes, is agreed in writing, with its fees, before it starts.
Request a Denials Economics Sprint and get overturn, cash, cost per claim and your break-even point for each claim-value band, for one payer and one denial class, measured against your own baseline.
