Claims denial cost calculator
Estimate the revenue you lose to preventable claim denials — and how much you could recover with pre-submission validation.
Your claims profile
Total claims submitted per year
Mean reimbursement per claim
Industry average: 5–15%
Denial reason mix
Code-level analysisOptional
Enter your top billed CPT/HCPCS codes for specific NCCI edit, MUE limit, and payment data from CMS.
Denial breakdown by reason
| Code | Reason | Denied | Preventable | $ Recoverable |
|---|---|---|---|---|
| CO-4 | Coding Error | 750 | 638 | $57,375 |
| CO-11 | Not Covered | 1,000 | 700 | $63,000 |
| CO-97 | Already Adjudicated | 600 | 570 | $51,300 |
| OA-23 | Not Authorized | 400 | 160 | $14,400 |
| CO-16 | Missing Information | 900 | 720 | $64,800 |
| CO-151 | MUE Exceeded | 600 | 570 | $51,300 |
How FHIRfly prevents denials
Most claim denials are preventable with the right data at the right time. Four API endpoints catch common denial reasons before claims leave your billing system — turning reactive rework into proactive validation.
NCCI PTP Validation
Query the CMS National Correct Coding Initiative procedure-to-procedure edits in real time. Before submitting a claim with multiple CPT codes, check whether code pairs are allowed, require a modifier, or are mutually exclusive — catching the most common coding denials before they reach the payer.
GET /v1/ncci/validate
MUE Limits
Medically Unlikely Edits cap the units of service per patient per day. FHIRfly returns the current MUE value and rationale for any CPT/HCPCS code, so your billing system can flag over-coded claims before submission.
GET /v1/mue/:hcpcs
PFS / RVU Data
Access the Medicare Physician Fee Schedule with work, practice-expense, and malpractice RVU components. Forecast reimbursement, find undercoded services, and validate that claims are complete before submission.
GET /v1/pfs/:hcpcs
Coverage Check
Verify that an ICD-10 diagnosis supports the billed CPT procedure per Medicare LCD/NCD. Coverage mismatches are the single largest category of denials — pre-submission validation eliminates them.
GET /v1/coverage/check
AI agent integration via MCP
Your AI coding assistant (Claude, GPT, etc.) can query all of these APIs in real time via FHIRfly's MCP server — automatically evaluating every claim before submission. No manual lookups.
Learn about MCP →