Decision brief: Where D-SNP and Medicaid Appeals and Grievances deadline clocks diverge.

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Provider Disputes ROI Calculator

Estimate the financial impact of streamlining your provider dispute operations

Enter your provider dispute operation’s data below to generate a three-scenario savings estimate. Every assumption is disclosed in full. Results are shown for three scenarios — Conservative, Moderate, and Aggressive — with the multipliers behind each printed below. Fields marked with an asterisk are required for calculation.
Volume & Process Metrics
Total provider disputes and payment appeals received annually across all channels
Time to log and set up one dispute at first touch (portal, fax, mail)
Time to pull claim, contract, and payment history and reach a determination
%
Disputes reopened or reprocessed due to incomplete intake or handling errors
Time spent correcting or re-processing a reopened dispute. Defaults to 40 if blank.
%
Disputes routed or assigned to a queue manually rather than by rule
Labor & Capacity
$
Fully loaded (salary + benefits + overhead)
Time to triage and assign one dispute manually. Defaults to 5 if blank.
Collected for context. Released capacity is derived from projected savings.
%
Expected year-over-year dispute volume increase
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