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Denied claims that paid7 openPayment integrity · largest paid amount firstCLAIMREASONOWNERPAID

C-50219No authorization on fileUM$18,400ApproveHold

C-52211Authorization denied, paid in fullPI$7,725ApproveHold

C-51150Authorization expired before serviceUM$3,340ApproveHold

C-48213Authorization denied, paid in fullPI$1,204ApproveHold

C-48977Denied, paid after the appeal windowPI$862ApproveHold

C-51092Denied, paid by the second payerCO$450ApproveHold

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authorization_caseclaim_headerinquiry_caseplan_design

EVIDENCE SO FARQueries0Sources0Rows0Analyzed0Knowledge0

Which denied authorizations still paid this plan year?

872 claims paid on a denied authorization this plan year, $2.0M.

1,284 claims matched a denied authorization. 412 had the denial overturned on appeal, so they come out of the count.

What I applied

The four endorsed pitfalls on these tables, including “Claims paid on an authorization that was denied”.

What I did not check

Expired authorizations still marked Approved. I can run that next.

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