Typical 90+ Day AR Bucket vs. 15% HFMA Benchmark
Annual Revenue Lost to Billing Inefficiencies (MGMA)
Recovery Rate Past 120 Days Without Specialist Help
To First Collectibility Score After Data Transfer
Your previous billing company ended its contract on a Friday. By Monday, the team was focused on new claims. The 60-day claims from the prior two months had no owner. They crossed 90 days. Some crossed 120.
At 90 days, most commercial payers — UnitedHealthcare, Aetna, and most BCBS state plans — are approaching or have already crossed their timely filing deadlines. Medicare Part B is the exception, with a
.
365-day filing window
from the date of service.
The most recoverable subset of aged AR is not what most practices expect: silent write-offs — claims removed from AR through an administrative adjustment entry without a corresponding payer denial code, while still within the timely filing window. QlaimPro identifies them in the
first 48 hours of every engagement.
Recovery rate for claims over 120 days without specialist intervention
Revenue cycle benchmarks
Recovery rate for claims under 60 days, by comparison
Revenue cycle benchmarks
Of net revenue lost annually to billing inefficiencies
MGMA Data
These are two distinct engagements with different workflows, payer contact strategies, and timelines.
A specific triggering event created the backlog and the percentage of total AR sitting past 90 days has grown well beyond benchmark.
Current claims keep moving because they're visible in the queue. Aged claims receive attention only when time is left over — which is rarely.
Once the recovery project closes, AR follow-up services engage as the ongoing prevention structure — so the backlog does not rebuild.
Old AR recovery addresses claims that have already aged past the billing team’s active follow-up cycle — typically 90 days or older. AR follow-up services manage the in-cycle collection process on claims from 0 to 90 days old. Old AR recovery is a defined project with a start date, a triage output, a recovery period, and a close.
Old AR does not accumulate from negligence. It accumulates from specific operational events that redirect attention away from aging claims at exactly the wrong moment.
Two to three months of biller vacancy moves $80,000 to $150,000 into the 90-plus bucket for a 5-provider group. No follow-up calls go out, no 277CA responses get checked.
Practices that rush migrations in under 21 days lose 8–12% of trailing AR — $160,000 to $240,000 on a $2M practice, invisible on any post-migration dashboard.
Outgoing vendors typically stop working old AR at contract termination. Incoming vendors classify pre-transition claims as out of scope. Exposure runs $50,000–$200,000.
Adding providers without proportional billing staff creates a structural capacity gap. A 120-plus day concentration problem develops within 6–9 months.
In 67% of practices, a single payer accounts for 35%+ of AR over 90 days — often a Medicaid MCO or Medicare Advantage plan generating pending status with no CARC code.
The claims that age during any of these events are not lost. They're recoverable — at the right payer, with the right documentation, before the filing window closes.
Begins the day we receive your aging data file. Completes within 60–120 days for most practice sizes. The first collectibility score arrives in 48 hours.
We pull the full aging report and sort claims by payer, bucket, dollar value, and denial code, then run the silent write-off audit — flagging claims removed from AR without a denial code while still within the filing window.
Every claim receives a score based on dollar value, payer type, proximity to filing expiration, and documentation completeness — separating recoverable claims from genuinely unrecoverable ones before any work begins.
For each active claim we identify the payer contact path and the correction route — CARC CO-15 triggers retro-authorization, CO-50 triggers a medical necessity appeal, CO-22 triggers COB coordination.
Corrected claims resubmit through the 837P electronic transaction pathway with frequency code 7. Appeals file within each payer’s window with the original claim number, denial code, and correction applied.
Every ERA payment is compared against the contracted fee schedule at the CPT-code level. Uncorrected underpayments account for 3–5% of total annual collections in a multi-payer group.
Every engagement closes with a root cause report identifying the workflow gap that produced the backlog — feeding directly into AR follow-up services so it doesn’t rebuild.
CARC code patterns, appeal strategies, and payer contact paths differ by clinical service type. Generic recovery applies one workflow to every specialty — we don’t.
Modifier 26/TC split failures on cardiac cath claims (CPT 93454, 93458) generate CO-4 and CO-97 denials. Humana MA audit holds sit pending with no CARC code for 60–90 days
Separate behavioral health administrators, separate portals. CPT 90837 authorization denials carry a federal MHPAEA parity appeal pathway most practices never use.
ESRD capitation denials for COB regenerate monthly until corrected. One COB fix on one patient can recover $4,000–$8,000 across stacked monthly claims.
Missing KX modifiers on CPT 97110/97530 above the therapy threshold sit in pending status for 60–90 days before appearing on the aging report at all.
Highest CO-15 concentration of any specialty. Retro-authorization on CPT 62323 and 64483 is granted more often than practices assume when the failure is administrative.
Mismatched conversion factors and missing QX/QK NPI linkage downcode claims automatically — invisible underpayments recoverable through formal contract dispute.
These numbers come from practices that ran a structured old AR recovery engagement with QlaimPro. Not projections.
Recovered in first 90 days when AR over 90 days exceeds 20%
Average days in AR vs. 40-day MGMA benchmark
AR over 90 days vs. 15% HFMA benchmark
Recoverable claim categories found in every 48-hour audit
QlaimPro’s audit came back in 48 hours with a recovery projection. We recovered $87,000 in 67 days. Our AR over 90 days dropped from 31% to 9% of total AR.
Pain Management Group — Dallas, TX
QlaimPro identified 34 claims as potential MHPAEA parity violations. We filed federal parity appeals on all 34. Thirty-one paid. We recovered $54,000 we had written off permanently.
Behavioral Health Group Practice — Chicago, IL
Our EHR migration left $120,000 in claims with no active owner. QlaimPro recovered $96,000 — 80% of total exposed AR — within 90 days, plus a root cause report.
Multi-Specialty Group — Houston, TX
Payment posting is the moment an overpayment is identified. What happens in the next 60 days determines whether the practice stays in compliance.
| Aging Bucket | Medicare Part B | Commercial | Medicare Advantage | Medicaid MCO |
|---|---|---|---|---|
|
61–90 days |
High (365-day window) |
High |
Moderate |
Variable by state |
|
91–120 days |
High |
Moderate to High |
Moderate |
Low to Moderate |
|
121–180 days |
High |
Low to Moderate |
Low |
Low |
|
181–365 days |
Moderate |
Low |
Very Low |
Very Low |
|
365+ days |
Low (exceptions only) |
Very Low |
Negligible |
Negligible |
| Payer | Original Claim Window | Appeal Window | Notes |
|---|---|---|---|
|
Medicare Part B |
365 days from DOS |
120 days (Level 1) |
Longest window; strongest recovery |
|
UnitedHealthcare (in-network) |
90 days from DOS |
180 days from denial |
Portal check required within 30 days |
|
Aetna (commercial) |
90 days from DOS |
60 days from denial |
Retro-auth up to 30 days post-DOS |
|
BCBS (by state) |
90–180 days |
60–180 days |
Verify state plan rules |
|
Humana (commercial) |
90–180 days |
60–180 days |
MA plans have audit hold patterns |
|
Medicaid MCO (by state) |
90–365 days |
State-dependent |
Verify state Medicaid rules |
The revenue damage from aged claims doesn’t show up on a monthly report. It compounds, silently, toward write-off.
MGMA puts the average cost to rework one denied claim at $118 in staff time — before accounting for claims that expire before staff reach them.
To rework 200 claims at standard cost
Claims past 120 days collect below 40% without specialist intervention, down from 80–90% under 60 days — and the drop accelerates daily.
Recovery rate once a claim crosses 120 days
Uncorrected payer contract variances post as routine adjustments — invisible to aging reports and denial workflows alike.
Of annual collections lost to underpayments
Six differentiators separate this engagement from standard billing company AR workdown services.
The 48-hour audit returns a claim-level report before any engagement fee is incurred.
The Business Associate Agreement is executed before any AR data file is transferred — not after the audit begins.
No multi-month retainer required to access the full 6-stage workflow. Scope and pricing are defined before work starts.
A 98.7% first-pass acceptance rate on forward claims means recovery runs alongside current operations, not in place of them.
We dispute payer contract variances during recovery — not just unpaid claims. Most practices accept underpayments as final. We don't.
Every engagement closes with a report and a direct handoff to AR follow-up services — so the trigger doesn't recur.
It’s the process of identifying, triaging, and collecting balances on claims that have aged past the billing team’s active follow-up cycle — typically 90 days or older. It’s a defined project with a start date, a triage output, an active follow-up period, and a close.
Below 40% without specialist intervention, compared to 80–90% under 60 days. The most immediately recoverable subset is silent write-offs — claims removed from AR without a denial code while still inside the filing window.
The 48-hour audit runs days 1–2. Active follow-up runs day 3 through day 14. Payment posting runs day 15 through day 120. Most engagements close within 60–120 days.
A claim removed from AR through an administrative adjustment without a corresponding denial code — not paid, not denied, not appealed, simply removed, often still within the filing window. We run this audit as the first 48-hour deliverable on every engagement.
A HIPAA BAA is executed before any data access. All transfers use 256-bit encryption, and our infrastructure runs under SOC 2 Type II compliance. No clinical record or EHR login access is required.
Yes. The audit requires only the AR aging report, the ERA transaction log, and the write-off transaction log — all exportable regardless of whether the legacy system is still in use. We verify claim status through the payer’s own portal.
We offer flat-fee project pricing and contingency-fee structures, typically 15–25% of recovered amounts with no fee on claims that don’t collect. The 48-hour audit is free regardless of pricing model, and all engagements run month-to-month.
Denial management addresses newly denied claims within 30–60 days, before they age into old AR. Old AR recovery addresses claims already past that window, often with no formal denial on file at all.
Cardiology, pain management, behavioral health, and nephrology consistently produce the highest recovery rates — each for specialty-specific reasons tied to modifier errors, retro-authorization policy, federal parity appeals, and COB corrections.
Typically 14–35 days after active follow-up begins, depending on the payer. Medicare Part B corrected claims pay fastest, in 14–21 days.
Every engagement closes with a root cause report and a handoff to AR follow-up services, which adds timely filing tracking, payer concentration monitoring, and transition protection going forward.
An export of your AR aging report, ERA transaction log, and write-off transaction log from your practice management system — that’s it. No clinical record or financial system access is required.
We score every claim in your 90-plus day bucket by collectibility, payer, and filing deadline, then hand you a dollar-quantified recovery estimate. The HIPAA BAA is executed before any data file is transferred — whether you sign with us or not.
