Appeal overturn rate calculator
Calculate your appeal overturn rate from the number of appeals a payer decided and the number it reversed in your favor.
Updated
Enter your own appeal figures to calculate your overturn rate — the share of the denials you challenged that the payer reversed.
Appeals the payer decided in your favor. Decide once whether a partial reversal counts here, and apply that rule every time.
Appeals that received a decision in the period. An appeal still pending has no outcome yet and does not belong in either figure.
Enter your figures to see the result and a breakdown.
How it’s calculated
Appeals overturned ÷ Appeals decided × 100
Count appeals decided in the period, not appeals filed: an appeal still pending has no outcome yet, and including it understates the rate. A partial reversal needs a consistent rule — count it as overturned or not, but the same way every time.
What this assumes
- Both figures must cover the same period, and both must count decided appeals — filed-but-pending appeals have no outcome, and including them understates the rate.
- A partial reversal is a judgment call this calculator does not make for you: count it as overturned or not, but apply one rule consistently or the trend is not comparable.
- The result is the arithmetic on the numbers you entered. It is not compared to a benchmark — and a high rate is not automatically good news, because it can mean appeals are well-built or that denials are being issued that should not have been. Read it beside how many denials you appealed, and why.
How to read the result
A higher overturn rate means more of the challenged denials were reversed. It does not straightforwardly mean the appeals process is performing well: a very high rate can mean appeals are well-built, or it can mean denials are being issued that should never have been issued, or that only the most certain cases are being appealed at all. A low rate can mean weak appeals, or that everything is appealed regardless of merit. Because the figure moves with which denials are selected for appeal, read it beside the volume appealed and the reasons behind them — and treat any external benchmark as directional, not a target.
Read the full appeal overturn rate definition