RecoveAR Case Study · Multispecialty Group

Sort the AR worklist by days to the filing deadline, not by dollars.

A multispecialty group had aging AR spread across Medicare, Medicaid, and a dozen commercial plans, each with its own timely-filing clock. Balance-first worklists kept sending callers to the biggest claims while smaller, fully recoverable ones quietly aged past the window.

The short answer: RecoveAR re-ranks every open claim by days-to-timely-filing-deadline first and balance second. Claims closest to their payer window surface at the top of the queue, so recoverable dollars get worked before the door closes for good.

AR by aging bucket

illustrative worklist

filing risk line

0–30
days

31–60
days

61–90
days

91–120
days

120+
days

The gold buckets are not always the biggest balances. They are the claims whose payer filing window is about to close. Deadline-first ranking pulls those to the front regardless of dollar value.

The clocks you are actually racing

Every payer keeps its own filing window. Miss it and the claim is unrecoverable.

These are not our numbers. They are the published limits that decide whether an aged claim is still money or already a write-off. A multispecialty group is juggling all of them at once.

12 months

Medicare timely-filing limit from the date of service

42 CFR 424.44 · ACA §6404

90–180 days

Typical commercial-payer filing window, set per plan

Payer provider manuals

Varies by state

Medicaid windows run from roughly 90 days to a year

State Medicaid provider manuals

$0 recoverable

Value of a clean claim submitted one day past the window

CMS Pub. 100-04, Ch. 1

The re-sort

Balance-first vs deadline-first: same worklist, different survivors

Most AR queues rank by outstanding balance, so a $40 lab charge two weeks from its filing cutoff sits below a $9,000 surgical claim with six months of runway. RecoveAR flips the sort key.

Balance-first worklist

Big dollars up top, deadlines invisible

× High-balance claims get all the caller attention, even when they have months of runway left.
× Small and mid-size claims age silently toward their filing cutoff at the bottom of the queue.
× A claim crosses its window and becomes a permanent write-off, not a denial you can appeal.
× Recoverable dollars are lost to the calendar, not to the payer's decision.

RecoveAR deadline-first worklist

Days-to-deadline is the primary sort key

✓ Each claim carries its payer's actual filing limit, counted from date of service.
✓ Claims nearest their window surface first, then balance breaks the tie within each urgency band.
✓ Callers spend effort where the calendar, not just the dollar amount, makes it non-negotiable.
✓ Fewer claims die of timeout, so more stay eligible to submit or appeal.

One claim, one clock

How a recoverable claim becomes a write-off

Illustrative path of a single commercial claim against a 90-day filing window. The point RecoveAR watches is not the balance, it is where the claim sits on this line.

Day 0

Date of service. Filing clock starts.

Day 30

Claim held or rejected at clearinghouse; still plenty of runway.

Day 60

RecoveAR flags it as approaching the window and lifts it in the queue.

Day 80

Urgent band. Worked and resubmitted with days to spare.

Day 91

Past the window. No longer appealable on timeliness.

The sprint, step by step

How the RecoveAR AR-aging recovery sprint runs

Load the filing rules

Attach each payer's real timely-filing limit to every open claim: Medicare's 12-month rule, the plan's commercial window, the state Medicaid window.

Compute days remaining

Count from date of service to the payer's cutoff for each claim. That figure, not the balance, becomes the primary sort key.

Rank and band the queue

Claims closest to their deadline rise to the top and split into urgency bands. Balance orders claims within each band.

Work before the window

Callers clear the most time-critical, recoverable claims first, so fewer age out of eligibility while high-balance claims with runway wait their turn.

Grounded in the rules that govern the clock

The filing authorities RecoveAR encodes

Medicare 12-month claim filing limit

Medicare requires claims be filed within one calendar year of the date of service. This is the hard outer limit for every Medicare line on the worklist.

42 CFR 424.44 · ACA §6404 (2010)

CMS claim submission rules

General billing and timely-submission requirements that define how the Medicare filing period is counted and when exceptions apply.

Medicare Claims Processing Manual, CMS Pub. 100-04, Ch. 1, §70

State Medicaid filing windows

Each state Medicaid program sets its own submission window, published in its provider manual. RecoveAR loads the state-specific limit rather than assuming a single default.

State Medicaid provider manuals

Payer timely-filing limits

Commercial and managed-care plans publish their own filing limits, commonly 90 to 180 days from date of service, in each plan's provider agreement and manual.

Individual payer provider manuals

Your AR is aging against a dozen different clocks. Work the closest ones first.

RecoveAR re-ranks your open AR by days-to-filing-deadline so recoverable claims get worked before the window closes, across Medicare, Medicaid, and every commercial plan you bill. If your worklist still sorts by balance, this is the change that stops calendar write-offs.

See RecoveAR on your AR →