Contract_Recovery_Audit_Workbook.xlsx

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1	V013-T2 · CONTRACT RECOVERY AUDIT WORKBOOK
2	Based on NYC Health + Hospitals v. UnitedHealthcare arbitration recovery ($40.1M, ~4,000 claims) \| RapidClaims
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4	WHY THIS WORKBOOK EXISTS
5	Most CFOs treat denied commercial claims as write-offs once the appeal window closes. The actual statute is the arbitration clause in your existing payer contracts — which typically allows recovery for the entire contract term (often 3-5 years), not just the appeal window. This workbook gives you the contract-clause checklist, the denial-categorization framework, the recovery pool calculator, and the readiness scorecard to convert historical denials into a recovery line item.
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9	WHAT'S INSIDE
10	TAB	WHAT IT CONTAINS	WHEN TO USE	TIME
11	1. README	How to use, color legend, disclaimer	First time only	5 min
12	2. Recovery Pool Calculator	Live calculator: denial volume → estimated recoverable pool, by category	Quarterly	30 min
13	3. Contract Clause Audit	4-clause checklist with scoring per payer contract	Per contract	20 min
14	4. Denial Category Recovery Map	Recovery probability table by denial reason code	Reference	10 min
15	5. Pool Sizing Decision Tree	5-criterion go/no-go scoring for arbitration filing	Per recovery opportunity	10 min
16	6. Readiness Scorecard	12-question quarterly review with live score	Quarterly	15 min
17	7. Sources & Change Log	Primary sources, version history, disclaimer	Reference	—
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20	COLOR LEGEND
21	LEVEL	MEANING	BG	TEXT
22	PURSUE	Recovery pool ≥5× arbitration cost — file	D5F0E1	0D7680
23	EVALUATE	Marginal case — strengthen evidence first	FDEBD0	D68910
24	APPEAL	Pool too small — route to internal appeal	FAD7D7	8B0000
25	EDITABLE	Enter your data in yellow cells	FFF9DB	1A1A1A
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27	DISCLAIMER
28	This workbook is an internal CFO and revenue-cycle education tool. It does not replace legal counsel. Arbitration clauses, lookback periods, and recovery rights vary by contract, jurisdiction, and case law. Always review your specific payer contract and consult counsel before initiating arbitration. Probability estimates are directional, drawn from publicly reported outcomes — not guarantees. Recovery cost estimates depend on case complexity and selected counsel. Not legal advice.
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