This report presents a detailed analysis of claims data received from the six managed care organizations (MCOs) contracted with DMAS. Comprising all claims submitted to the MCOs during a five-year period between July 1, 2017, and June 30, 2022, this data distinguishes both claims denied, and claims denied but paid upon resubmission as well as the reasons behind those denials. All claims’ data has been reported by provider type corresponding to the billing provider.

For the purposes of this report, each claim line item was counted as one claim. This approach precluded counting a single claim as both paid and denied in the event that a claim contained both paid and denied line items. Where multiple line items within a single claim were denied, but for different reasons, each line item was counted only within the claim totals for the denial reason(s) that applied to that line item. The term “claim" throughout this report should be regarded as equivalent to “claim line item."

Of more than 372 million claims submitted during the report period, almost 77 million, or nearly 21% of claims submitted, were at least initially denied. The report breaks down the reported claims data into the following categories:

• Total Claims Submitted to MCOs by Provider Type
• Total Claims Paid by MCOs by Provider Type
• Total Claims Paid Only After Resubmission by Provider Type
• Total Claims Denied by Provider Type
• Top Claim Denial Reasons (>= 100,000 claims)
• Top Claim Denial Reasons by Provider Type (>= 100,000 claims)
• Top Original Denial Reasons for Claims Paid Only Upon Resubmission (>= 10,000 claims)
• Top Original Denial Reasons for Claims Paid Only Upon Resubmission by Provider Type (>= 10,000 claims)