Why this step decides whether the claim gets paid
Aged receivable rarely reflects one large failure. It accumulates from claims that were denied and never reworked, underpayments that were posted without comparison to the contracted rate, and follow-up that stopped after a single attempt.
Accounts Receivable (AR) Management capabilities
AR aging analysis
Receivable segmented by aging bucket, payer, and denial reason so effort is directed at what is both collectible and material.
Payer follow-up
Systematic follow-up on unpaid claims through payer portals, representatives, and electronic claim status, with each contact documented.
Denial management and appeals
Denials worked by root cause, corrected and resubmitted where appropriate, or appealed with supporting documentation within the payer's appeal window.
Underpayment identification
Payments compared against expected contracted reimbursement so partial payments are identified rather than accepted as final.
Claim status monitoring
Claim status tracked using the HIPAA X12 276/277 transaction set where the payer supports it, rather than waiting for a remittance that may never arrive.
Old AR cleanup projects
Legacy receivable reviewed against timely filing and appeal deadlines, with a candid assessment of what remains recoverable.
Our accounts receivable (ar) management process
Analyze the aging
Current receivable is segmented by age, payer, and reason so priorities are based on evidence.
Categorize by root cause
Unpaid claims are grouped by why they are unpaid: denial, rejection, no response, underpayment, or patient balance.
Work high-value and time-sensitive first
Claims approaching timely filing or appeal deadlines are prioritized alongside high-dollar balances.
Correct and resubmit
Claims denied for fixable reasons are corrected and resubmitted with the necessary documentation.
Appeal where warranted
Denials that are incorrect are appealed in writing with clinical or contractual support.
Report and prevent
Recurring denial patterns are reported back so the upstream cause is addressed rather than reworked every month.
Accounts Receivable (AR) Management questions answered
Accounts receivable follow-up is the work of pursuing claims that have been submitted but not paid. It includes checking claim status with the payer, identifying why payment has not been made, correcting and resubmitting claims where the issue is fixable, appealing incorrect denials, and escalating claims the payer is holding without a valid reason.
AR aging groups outstanding balances by how long they have been unpaid, commonly in 30-day buckets such as 0-30, 31-60, 61-90, 91-120, and over 120 days. Aging matters because the probability of collection generally falls as a claim ages, and because payer timely filing and appeal deadlines eventually close the opportunity entirely.
A rejection occurs before the claim is accepted for processing, typically at the clearinghouse or in the payer's front-end edits, because of a formatting or data error. A denial occurs after the claim has been processed and adjudicated, when the payer decides not to pay. Rejections are corrected and resubmitted; denials often require an appeal or a documented correction.
X12 276 and 277 are the HIPAA-standard electronic transactions for claim status inquiry and response. The 276 asks the payer about the status of a submitted claim and the 277 returns that status. Where a payer supports it, this allows claim status to be checked electronically rather than by telephone.
Some of it, depending on payer timely filing limits, appeal deadlines, and why the claim went unpaid. Claims past the filing deadline with no valid exception are generally not recoverable from the payer. We review legacy AR against those deadlines and report what is realistically collectible rather than working balances that cannot be recovered.
By tracing denials to their root cause and fixing it upstream. A denial pattern usually points to something specific such as missing prior authorization, a coding combination the payer rejects, incorrect patient demographics, or a credentialing gap where the rendering provider is not properly enrolled with that payer. Reporting the pattern lets the cause be addressed once.