Low coverage
Near zero
- Claims are not adjudicated at all
- Route to payer enrollment and ERA/EFT setup
Home / Case studies / ABA
Case study · Multi-state ABA · Diagnostic method
ABA first-pass yield: the 65.8% that hid inside a 92.5% report
Short answer: a multi-state ABA and pediatric therapy nonprofit collected 85 cents on the contracted dollar while its first-pass yield looked healthy. Counting silence as failure turned 92.5% into 65.8%. Four tests any ABA group can run on its own billing export.
334,635 billed lines · 2022 to Aug 2026
6 states · one cutover
$5.05M · never answered
Lines
334,635
Period
2022 to Aug 2026
Metric
True FPY 65.8%
Silent
$5.05M never answered
States
6, one cutover
Status
Diagnostic
65.8%
True first-pass yield; the first report said 92.5%
$5.05M
Claimed and never answered: no payment, no denial, no remit line
73.1%
Of billed contract value ever paid in full, even after all rework
8.6%
First-pass denial rate; 49.8% of denied dollars recovered
The baseline is published; this is the method
The baseline: a multi-state ABA group where the missing money was never denied. Here: how 92.5% became 65.8%, plus three tests that assign each fix to enrollment, follow-up or the front desk.
- 222022Net collection on contract value 95.1%
- 23202388.3% as the book grows
- 24202484.4%
- 25202585.3%
- SSep 2026Full-history diagnostic, every line and remit
- CSep to Oct 2026Single-date cutover; results not yet measured
NCR on contract value
95.1%
88.3%
84.4%
85.3%
Diagnostic, then cutover inside the client's own system
Collected 95%+Collected 84 to 88%ASP-RCM diagnostic and cutover
Define first-pass yield so silence counts as failure
The client's 92.5% called a line clean if it carried no denial code. A never-adjudicated claim carries none either. We redefined it as contract value paid in full on the first remittance, unanswered claims counted as failures.
Three ways to read the same 335,000 billed lines
Share of billed contract value, 334,635 lines, 2022 to August 2026.
Naive first-pass yieldno denial code = clean
92.5%as reported
True first-pass yieldpaid in full on first remit
65.8%-26.7 pts; silence counted as failure
Ever paid in fullafter every appeal and rebill
73.1%rework recovered 7.3 pts
First-pass denial ratepayer said no
8.6%the only part a denial report sees
025%50%75%100%
Naive countTrue first-pass yieldAfter reworkDenied
Takeaway
A denial creates a worklist item. A never-answered claim creates nothing, and a 'no denial code' metric rewards it.
Split the open receivable into three parts that add up
Open receivable on contract value, 2022 to August 2026
Three parts, no overlap. The silent middle is the story.
4.8%
$5.05MNever answered · 60.6%
$2.88MAnswered, open · 34.6%
Never claimed$402K · 4.8%Front-desk and charge-capture gap
Claimed, never answered$5.05M · 60.6%No payment, no denial, no remit line
Answered, left open$2.88M · 34.6%Denials were 7.9% of lines; 49.8% of denied dollars recovered
| Inside the silent $5.05M | Contract value | What it means |
|---|---|---|
| Submitted over 60 days ago | $4.13M | Needs a status inquiry, not a rebill |
| Submitted over one year ago | $3.44M | Mostly past timely filing: dispute or reserve |
| Denied lines, whole book | 7.9% of lines | 49.8% of denied dollars recovered; denial management was not where the money was |
Remittance coverage per payer is the enrollment detector
Coverage: the share of billed lines that ever produced a remittance line. A payer that adjudicates answers almost everything, even when the answer is no.
Middle coverage
Part of the roster
- Part of the roster or membership is not registered
- Audit enrollment and eligibility together
High coverage
The payer answers
- Silent dollars here are a claim-status discipline problem
- Belongs to billing, not credentialing
One state after an enrollment repair
Net collection on contract value by service year; the client repaired enrollment before we arrived
16%2024services
23%2025+7 pts
55%2026+32 pts
The out-of-state Blue plan inside it
4% remittance coverage, 4% net collection, $424K silent before the repair
0%2024services
1%2025services
19%2026+18 pts
Takeaway
Remittance coverage splits the fix: low coverage belongs to credentialing, high-coverage silence to billing.
Cohort cash velocity, never measured on paid lines
Whole-cohort share of each service year's contract value collected by day 30, 90 and ever. The book collects faster and collects less.
Share of service-year contract value collected, by day
11%2022day 30
76%2022day 90
95%+19 pts tail2022ever
40%2025day 30
78%2025day 90
85%+7 pts tail2025ever
2022 services2025 servicesThe 2025 tail after day 90 is the $5.05M
| Measure | Value | Reading |
|---|---|---|
| Days in AR, legacy-inflated | 237 | Years of unresolved history; a write-off question |
| Days in AR, current book | 84 | The operating number for today's claims |
| Tail after day 90, 2022 services | 19 points | 76% to 95%: follow-up kept collecting |
| Tail after day 90, 2025 services | 7 points | 78% to 85%: the tail is the $5.05M |
The method, as a monthly routine
We work inside the client's own practice management system under its existing enrollments: one date-of-service cutover across six states, four weeks to cutover, eight to steady state. Plan agreed; cutover not yet measured.
1
True first-pass yieldmonthly
Paid in full on the first remittance; unanswered claims count as failures.
2
Three-part receivableadds to the total
Never claimed, never answered, answered and open, in dollars.
3
Coverage by payerroutes the fix
Low coverage goes to enrollment; high-coverage silence goes to claim status.
4
Cohort velocityday 30, 90, ever
Share of each service month's contract value collected, on the whole cohort.
5
Single-date cutover6 states
Work inside the existing system and enrollments; never split the book.
Reported as measured, including what is not yet
- TBDNo post-cutover before-and-after exists yetThe cutover ran in September and October 2026; the first measurement under our process is still maturing.
- 28%Family responsibility sits inside contract value$1.74M of copays billed, 28% ($486K) collected, so 100% net collection is not a reachable target.
- 1yr+Claims over one year old are mostly past filing limitsA dispute-or-reserve decision, not a recovery we forecast.
- 0
Frequently asked questions
What is the difference between naive and true first-pass yield in ABA billing?
Naive first-pass yield counts a line as clean when it carries no denial code, so never-adjudicated claims inflate it. True first-pass yield is contract value paid in full on the first remittance, with unanswered claims counted as failures. Here: 92.5% naive, 65.8% true.
How do you tell an enrollment problem from a follow-up problem?
Measure remittance coverage per payer: the share of billed claim lines that ever produced a remittance line. Near-zero coverage points to enrollment or ERA setup; high coverage with silent dollars is a claim-status problem.
Why measure cash velocity on the whole cohort instead of paid lines?
Velocity computed on paid lines ignores every line never paid, so a book can look fast while much of its value is still open. Cohort velocity divides cash by the service year's whole contract value, so it reconciles to the collection rate.
- 42 CFR 447.45, Timely claims payment: definition of a clean claim; 90% of clean claims paid within 30 days and 99% within 90 days (eCFR)
- 42 CFR 447.46, Timely claims payment by MCOs: contracts must meet 447.45(d) unless an alternative schedule is agreed (eCFR)
Checked October 27, 2026. Engagement figures are from ASP-RCM records and the client's own exports; the client is described by type only.
Measure your true first-pass yield
Send a billing export and a remittance export. We compute first-pass yield with silence counted as failure, and remittance coverage per payer.