Maven One Health
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TAHP · TX Covered 2026

What's your payment accuracy gap costing you?

Provider data and configuration accuracy quietly drive two costs most plans underestimate: pend-processing overhead and denial rework. Adjust the inputs below to see your plan's exposure.

Your Plan — Adjust the Inputs
Plan Membership 100,000
Total enrolled members
10K500K
Auto-Adjudication Rate 75%
Industry mid = 75%; best practice = 85%+
55%95%
Initial Denial Rate 11.8%
2024 industry avg = 11.8% (Kodiak/HFMA)
5%20%
Locked Assumptions
$0.90 auto-adj cost/claim
$20.00 pended claim cost
$47.77 denial admin cost (MA)
2 claims/member/mo
70% denials overturned
50% denials = data issues
Your Estimated Exposure
Pend Cost Gap Wolters Kluwer benchmark
Annual claims 2,400,000
Pended claims 600,000
Total pend processing cost $12,000,000
vs. 85% auto-adj benchmark —
Denial Rework Cost HFMA / Kodiak 2024
Denied claims / yr 283,200
Total denial admin cost $13,530,240
Data-driven denials (50%) 141,600
Rework cost, data-driven denials $6,765,120
Combined Estimated Exposure
Pend cost gap + data-driven denial rework
Provider data and configuration accuracy are material drivers of both figures.
$8.67M

See what accurate claims pricing can move for your plan. Request a Kestrel enterprise demo and we'll set up time personally — no commitment required.

Pend cost benchmarks ($0.90 / $20.00 per claim) sourced from Wolters Kluwer Health Language. Denial admin cost ($47.77/MA claim) and denial rate (11.8%) from HFMA / Kodiak Solutions, 2024. Overturn rate (70%) from Premier Inc. 50% data-driven denial attribution from Experian Health 2025 State of Claims survey; this category encompasses all data quality issues, of which provider data is a subset. Model is illustrative; actual plan results will vary.