QlaimPro works every unpaid claim through payer-specific AR follow-up — tracking aging buckets, enforcing timely filing deadlines, identifying underpayments, and turning stalled balances into collected revenue before recovery windows close.
Free 7-days AR audit. No clinical or financial system access required. Month-to-month, no lock-in.
First-Pass Acceptance Rate
Average Revenue Increase
Agreements — No Lock-In
Active Practices
AR Audit Results
The gap between submitting a claim and collecting payment is where most independent practices lose the most recoverable revenue — not through one catastrophic denial, but through the slow accumulation of claims nobody followed up on.
A claim moves from the 30-day aging bucket into the 60-day bucket. Then into the 90-day bucket. Meanwhile, payer-specific timely filing deadlines run in the background. Humana cuts off at 90 days. Aetna commercial plans cut off at 120 days. When a claim crosses those windows without follow-up, the balance converts to a
CO-29 denial — a permanent write-off with no appeal path and no patient billing option.
AR follow-up services at QlaimPro classify every outstanding claim by aging bucket, payer timely filing deadline, and denial reason code — then work them in the sequence that protects the most revenue before recovery windows close.
Industry-wide initial claim denial rate in 2024 — up from 10.2% the year before. Each denial adds 15–30 days to AR, retroactive to the original service date.
HFMA Benchmarks, 2024
Of total AR sitting past 90 days signals a structural collection failure, not a temporary variance, per MGMA benchmarking data.
MGMA Benchmarks
Of denied claims are never followed up. For a mid-sized provider group, that gap costs more than $150,000 annually in unrecovered revenue.
MGMA
Claims that pass the 120-day threshold recover at less than 40% of their original value, according to MBC Revenue Performance Benchmarks 2025–2026. That is not a billing inconvenience. It is a cash-flow emergency with a closing window.
Every payment QlaimPro processes QlaimPro’s AR follow-up process runs 7 operational stages — from aging classification and timely filing triage through payer-specific outreach, underpayment identification, escalated appeals, and root cause reporting. Each stage has a defined input, action, and output. Nothing runs on intuition.moves through 6 defined stages, from remittance receipt to bank reconciliation. Nothing is posted without passing through each one.
Every outstanding claim is pulled from the AR aging report and assigned to one of 5 aging buckets: 0–30, 31–60, 61–90, 91–120, and 120-plus days. Each claim then receives a recovery priority score based on dollar value, payer timely filing deadline proximity, and prior denial history.
The 61–90-day bucket receives the highest priority — it still carries full recovery probability while facing the highest timely filing risk. The 120-plus day bucket moves into the Old AR Recovery workflow, run separately from active follow-up.
Before any outreach begins, every claim in the 31–90 day range is checked against the specific payer’s timely filing deadline. Medicare gives 12 months under 42 CFR §424.44. Humana gives 90 days. Aetna commercial gives 120 days. UHC commercial ranges 90–180 days by contract. Any claim within 30 days of its deadline is flagged as a timely filing emergency and moves to the front of the queue, regardless of dollar value. A claim that misses its window receives a permanent, non-appealable CO-29 denial.
UHC and Aetna respond through online dispute portals with defined response timelines. Medicare Redetermination submits through the CMS portal within 120 days of denial. Medicaid follow-up runs through state-specific channels that vary by state and MCO. QlaimPro follows each payer’s own protocol — not a generic script applied equally across a Humana PPO claim, a Medicare Part B claim, and a UHC Medicare Advantage claim, which have three different escalation paths and documentation requirements.
Denied claims are categorized by CO and PR reason codes. CO-4 signals a modifier issue. CO-22 indicates wrong coordination of benefits sequencing. PR-96 points to non-covered charges. Each category has a specific correction path that determines first-attempt success. At this stage, AR follow-up and denial management overlap — a claim that ages into an explicit denial exits the AR queue and enters denial rework. QlaimPro runs both simultaneously so no claim falls between them.
Every remittance advice is reconciled against the contracted fee schedule before a contractual adjustment is posted — catching cases where a payer reimbursed below the contracted rate and marked the claim paid. This produces no denial code and no system alert. Underpayments below the per-claim dispute threshold are aggregated by payer and disputed in bulk. Commercial payers underpay by 7–11% of total payment value, per MGMA estimates — systematic variance that compounds silently.
Claims reaching a final denial after standard follow-up escalate to Level 1 formal appeal — complete documentation, the specific denial reason addressed, filed within the payer’s window. Medicare Redetermination gives 120 days; commercial windows run 60–180 days. Up to 90% of denied claims are recoverable if worked within the appeal window, per MGMA — provided the appeal mirrors the payer’s own denial language back against the clinical evidence, not a generic medical-necessity letter.
Every worked claim generates a data point — denial reason, payer behavior, aging pattern, filing proximity — feeding a monthly root cause report on the upstream billing failures that created the AR problem. QlaimPro’s 98.7% first-pass acceptance rate reflects what happens when AR follow-up data informs claim submission quality upstream. Clean claims at the front end do not generate the aged AR follow-up exists to recover.
A timely filing deadline is the payer-imposed period within which a provider must submit a claim after the date of service. Miss it, and recoverable AR converts to a permanent write-off — no appeal path, no patient billing option.
CO-29 is the denial reason code a payer issues when a claim arrives after the timely filing deadline. It converts a billable balance into a permanent write-off — the amount cannot be recovered through formal appeal and cannot be transferred to the patient. QlaimPro's timely filing triage flags every claim within 30 days of its payer-specific deadline, before CO-29 becomes the outcome.
Payer variance analysis reconciles every remittance advice against the contracted fee schedule before posting an adjustment — catching reimbursements below the contracted rate that close silently as “paid,” with no denial code and no system alert.
A claim closes as paid. The remittance shows $310 for a service contracted at $350. The $40 difference posts as a contractual adjustment and the account clears. No one flags it. No dispute is filed. The $40 is gone.
$8,000is the cumulative underpayment across just 200 Aetna claims in a single quarter. Across four quarters: $32,000 in permanent annual loss — permanent because dispute windows close 90–180 days post-remittance.
According to MGMA estimates, commercial payers underpay providers by 7–11% of total payment value. A separate Becker's Hospital Review study found providers lose 1–3% of net revenue annually to underpayments — a systematic pattern, not random error.
Every remittance reconciliation runs against the contracted rate in the fee schedule before the adjustment is posted. Underpayments below the per-claim dispute threshold are not discarded — they're batched by payer and disputed in aggregate.
The diagnostic is straightforward: if net collection rate runs below 90% while clean claim rate sits above 95%, systematic underpayment acceptance is the most probable cause. The gap points to remittance variances posting unchallenged.
QlaimPro identifies and disputes underpayments in the current remittance cycle — not retrospectively, once the dispute window has already closed. That is the only window in which recovery is possible.
AR aging patterns differ by specialty because the underlying denial causes differ. Each specialty has payer-specific claim rules, modifier requirements, and documentation standards — and a generalist AR workflow systematically under-recovers on all of them.
Aging most often originates in global surgical period disputes, professional vs. technical component conflicts, and medical necessity denials on echo and stress testing. Modifier 24/79 disputes are prioritized as the highest-recovery category — consistently correctable, consistently missed.
Aging most often originates in carve-out disputes routed through UBH, Magellan, or Beacon Health, MHPAEA parity denials, and telehealth parity delays. QlaimPro works the carve-out entity directly and tracks both payer entities in the aging report for every account.
Aging most often originates in concurrency rule denials and QK/QX modifier disputes. When a supervising physician directs more than four concurrent cases, claims pay at the QK rate — a systematic underpayment that posts as a contractual adjustment with no denial code.
Aging most often originates in Medicare maintenance-therapy denials under the AT modifier standard and CPT 98941 vs. 98940 downcoding. SOAP notes must document measurable functional improvement between visits — not just a "stable" condition note
Aging most often originates in interventional procedure prior auth disputes and fluoroscopy bundling denials. CPT 62323 denials require operative note language naming the imaging modality and confirming real-time guidance — not a generic "fluoroscopy was used" statement.
Aging most often originates in timed CPT billing errors under the 8-minute rule and functional limitation reporting gaps. Resubmission requires a recalculated unit count from documented treatment minutes — not a re-assertion of the original units.
QlaimPro’s AR follow-up services reduce days in AR, lower the share of AR past 90 days, and improve net collection rate — measured within the first 90 days of engagement across practices in multiple specialties and states.
First-Pass Acceptance Rate
Active Practices
Average Revenue Increase
Agreements, No Lock-In
Our behavioral health AR was sitting at 67 days when we brought in QlaimPro. Within 90 days we were at 38 days. The carve-out dispute process they ran on our UBH claims recovered $31,000 we had already written off mentally.
3-Provider Behavioral Health Group — Chicago, Illinois
I had no idea our Aetna cardiac catheterization claims had a 120-day filing window. QlaimPro moved that follow-up to day 60 and our 90-day AR bucket dropped from 19% to 7% in one quarter — roughly $44,000 in recovered revenue.
Cardiology Practice — Dallas, Texas
QlaimPro found $22,000 in UHC underpayments on our CPT 62323 claims that had been closing as paid for eight months. Every claim was within the dispute window. We had no idea the variance existed.
5-Provider Pain Management Group — Houston, Texas
In-house and outsourced AR follow-up produce different outcomes across six measurable dimensions — cost structure, payer expertise, timely filing oversight, underpayment detection, scalability, and reporting depth.
Every answer here is complete. You should not need a sales call to understand what you are considering.
QlaimPro executes the HIPAA Business Associate Agreement before accessing any claim data. Following BAA execution, the 48-hour AR audit classifies outstanding claims by aging bucket, payer timely filing risk, and dollar value. Active follow-up on priority claims — those in the 61–90-day bucket with filing deadlines within 30 days — begins within 72 hours of audit completion. New claim follow-up runs on a daily cycle from the first full day of engagement.
Claims in the 90-day bucket are fully workable under standard AR follow-up. The timely filing window remains open for Medicare (12 months), UHC commercial (up to 180 days), and most BCBS state plans. Claims at 120 days require payer-specific verification — Aetna commercial may be near its 120-day limit, and Humana’s 90-day window is already closed. Claims past the window with no valid exception qualify for the Old AR Recovery workflow, which documents the write-off, identifies root cause, and prevents recurrence.
An AR aging report categorizes outstanding claims and patient balances by how long they’ve remained unpaid — organized into 0–30, 31–60, 61–90, 91–120, and 120-plus day buckets. QlaimPro uses it to assign follow-up priority: the 61–90-day bucket gets the highest attention because it carries both the highest recovery probability and the highest timely filing risk simultaneously. MGMA benchmarks hold that AR over 90 days should stay below 13.5% of total AR in a healthy revenue cycle.
A timely filing deadline is the payer-imposed period within which a provider must submit a claim after the date of service. Deadlines range from 90 days (Humana) to 12 months (Original Medicare), with most commercial payers setting 90–180 day windows. A claim submitted after the deadline receives a CO-29 denial — a permanent write-off that cannot be appealed or billed to the patient. QlaimPro’s triage flags every claim within 30 days of its payer-specific deadline to prevent this outcome.
Medicare follow-up runs through the CMS Redetermination process — a formal appeal structure with a 120-day filing window from the denial date, governed by 42 CFR §424.44. Commercial follow-up uses each payer’s own dispute path: UHC routes through an online provider portal, Aetna through provider relations, and Humana requires phone follow-up with documented call records including representative ID and reference number. A single script applied across all payers produces inconsistent results because the escalation paths are structurally different.
CO-29 is the denial reason code a payer issues when a claim arrives after the timely filing deadline. It converts a billable balance into a permanent write-off — the amount cannot be recovered through formal appeal and cannot be transferred to the patient as a balance due, regardless of whether the underlying claim was clinically valid. The only way to prevent CO-29 losses is to follow up claims before the payer’s filing window closes, which requires knowing each payer’s specific deadline rather than a generic schedule.
Payer variance analysis compares each remittance advice against the contracted fee schedule before a contractual adjustment is posted. When a payer reimburses below the contracted rate and the variance posts without dispute, it becomes permanent once the payer’s dispute window closes — typically 90–180 days post-remittance. Commercial payers underpay providers by 7–11% of total payments per MGMA estimates. Practices that skip variance analysis accept these underpayments as correct, suppressing net collection rate by 1–3 points without knowing the cause.
AR follow-up works claims that have been submitted and are waiting for payment — tracking status, enforcing timely filing deadlines, and identifying claims aged without action. Denial management works claims that received an explicit payer rejection with a reason code, correcting and resubmitting with documentation. The two meet when an aged claim receives an explicit denial: it exits the AR aging queue and enters denial rework. QlaimPro runs both simultaneously through an internal handoff so no claim falls between them.
QlaimPro’s monthly report covers six KPIs: days in AR (target below 40, per MGMA), AR over 90 days as a percentage of total AR (target below 13.5%), net collection rate (target 94–97% for high performers), first-pass acceptance rate (target 98.7%), denial rate (target below 8% post-outsourcing), and payer-level timely filing proximity for the 60–90-day bucket. The report also includes the underpayment recovery total for the period and a root cause breakdown of all worked denials.
A contractual adjustment is a pre-agreed fee schedule reduction — the gap between a provider’s billed charge and the payer’s contracted allowed amount. It’s expected and budgeted, not a revenue loss. An AR write-off is revenue that cannot be collected — due to a CO-29 denial, a final medical necessity denial with no remaining appeal path, or a patient balance written off as bad debt. The distinction matters: adjustments are predictable, while write-offs represent recoverable revenue lost through a billing failure.
Each specialty generates payer-specific denial patterns requiring specialty-specific follow-up. Mental health AR requires tracking carve-out entities separately from the primary plan. Cardiology requires global surgical period and modifier 26/TC expertise. Anesthesia requires concurrency rule analysis to catch QK vs. AA underpayments. Pain management requires LCD-specific appeal documentation. Physical therapy requires 8-minute rule unit recalculation. A generalist workflow applies the same process to every specialty and under-recovers on each one’s specific patterns.
Claims past the timely filing window with no valid exception receive a write-off documentation package — a structured record identifying the exact amount, payer, denial code, date of service, and root cause of the missed window. QlaimPro categorizes each write-off by root cause: submission delay, authorization miss, eligibility gap, coding error, or staffing gap. That data feeds the front-end process improvement report, so every write-off generates a specific upstream fix rather than repeating next quarter.
QlaimPro’s AR follow-up audit classifies your outstanding claims by aging bucket, identifies claims within 30 days of their payer timely filing deadline, and quantifies the revenue still recoverable before write-off windows close.
Your 7-Days audit includes four specific deliverables:
