BH Denial Recovery Rate Benchmarks by Payer — 2026

Industry Overall

• Average denial rate: 10-14%
• Best-in-class denial rate: 5-7%
• Recovery rate on appeals: 45-65%
• Root cause: payer-specific edit rules + MHPAEA parity gaps

Payer-Specific Denial Rates (BH-specific)

• Optum Behavioral Health: 12-16% (highest downcoding rate on 90837)
• Carelon Behavioral: 9-13% (aggressive on ASAM level challenges)
• Beacon Health Options: 10-14% (state-specific variance)
• Aetna BH: 8-12% (cleaner than average)
• UnitedHealthcare Commercial: 9-13%
• Cigna BH: 8-11% (cleanest of the majors)
• Anthem BCBS: 10-15% (regional variance)
• State Medicaid MCO: 8-20% (extreme state variance)

Appeal Recovery Rate by Payer

• Optum BH: 50-65% (high recovery when 90837 time doc included)
• Carelon: 55-70% (high recovery with ASAM Multidimensional)
• Beacon: 45-60%
• Aetna BH: 60-75% (best appeal environment)
• UHC Commercial: 50-65%
• Cigna BH: 55-70%
• State Medicaid MCO: 40-60% (varies by state)

Revenant Care Denial Recovery Services

– KD, Revenant Care