A multi-site nonprofit health center with medical, dental and behavioral health lines; behavioral health and substance use carry much of the volume, paid by Medicaid managed care at a fixed encounter rate. We took over coding, billing, posting, follow-up and credentialing support on June 9, 2026. The first 70 days are published; this page picks up at month four.
Same dated transaction extracts each month, like for like. Largest remaining reason: a procedure-to-provider-type edit on one payer, an enrollment correction.
Median lag 15 days at takeover
Eased by mid-October; new cash clears young claims first
A denial inventory can only fall as fast as remittances are posted. Posting timeliness went first; the denial curve followed.
On August 11 we computed every SLA the data could support, from the client's extracts rather than our own reports, and three behavioral measures were breaching. By October the clean claim rate was above its SLA, but denial turnaround was still eight times its target. An operator deciding whether to outsource behavioral health billing needs both halves.
| Measure | Actual | Target | Status |
|---|---|---|---|
| Behavioral AR over 120 days (Aug 11) | 40.5% | 25% or less | Breach |
| Authorization share of behavioral denials (Aug 11) | 6.7% | 5% or less | Breach |
| Credentialing denials, share of denials (Aug 11) | 9.2% | 2% or less | Breach |
| Denial turnaround (Oct) | 41.36 days | 5 days | Breach |
| Clean claim rate (Oct) | 95.51% | 95% or more | Met |
| Open AR over 90 days (Oct 12) | 49.58%, was 52.8% | Tracked | Improving |
Bar is the actual as a multiple of its target; the target line is 1.0x.
$276,644 adjusted in four months
57% of 2026 denial dollars
6.7% against a 5% ceiling
AR behind an open denial is re-derived every month from dated transaction extracts, never from a worklist count, so the trend cannot be flattered.
Remittance posting moved to a daily cadence first, because an unposted denial cannot be worked.
Every denial class routes to the team that owns the cause: enrollment, intake authorization, coding or payer dispute.
A 100% pre-bill coding review queue for encounter claims, so whole-visit denials are prevented rather than appealed.
Contract SLAs computed from the client's extracts and shown to the board with breaches marked, not summarized away.
The open insurance balance on accounts that carry an unresolved denial, taken from dated transaction extracts at each month end. It fell from $1,424,386 at go-live to $655,508 on September 30, 2026, a 54% reduction, and was lower at every month end than the one before.
Because an operator comparing behavioral health billing services needs the misses with the wins. On August 11, behavioral AR over 120 days was 40.5% against a 25% ceiling, authorization-related denials were 6.7% of behavioral denials against 5%, and credentialing denials were 9.2% against 2%. Denial turnaround in October was 41.36 days against a 5-day SLA.
A denial that has not been posted is invisible to the follow-up team. Cash posted within seven days of receipt went from 16% at takeover to 59% in July, and the denial inventory fell in every month after.
It is above the 95% contract SLA, but no clean claim rate was measured before the handover. The nearest comparison is the client's own September figure of 93.32%, so we present October as meeting the SLA rather than as a measured improvement.
Checked October 27, 2026. Engagement figures are from ASP-RCM records and the client's own exports; the client is described by type only.
We re-derive AR behind open denials from your own extracts, map each denial class to its owner and show which contract measures would breach today.