AR & denials
Unpaid and denied claims worked from a real worklist, oldest and largest first, with the denial read properly and an escalation path that ends in a person.
- 0-30 days
- Working
- 31-60 days
- Appeals filed
- 61-90 days
- Escalated
- 90+ days
- Backlog run
- Every bucket has an owner
- ✓
Four things, worked oldest first
Every open claim in an aging bucket with an owner and a next action, not a spreadsheet that gets re-sorted.
Denials categorised by cause so the same rejection stops arriving next month.
Appeals prepared and filed inside the payer's window, with the documentation attached.
Backlog clean-ups taken on alongside ongoing billing, worked highest-value first.
What actually happens
The worklist is rebuilt from the current aging: oldest and largest first, each claim assigned rather than left in a pile.
Appeals go out inside the payer window with the documentation already attached, and each one is logged against the claim it belongs to.
Anything stuck with a first-line representative is escalated to someone who can actually decide it.
Denials are ranked by cause and by what they cost, so the fix for next month is obvious rather than theoretical.
What we take on
Our desk- 01Building and maintaining the aging worklist
- 02Categorising every denial by cause
- 03Preparing and filing appeals in the window
- 04Escalating past first-line representatives
- 05Clearing historical backlog alongside daily work
What stays yours
Unchanged- Your dispensing system and your data inside it
- Your payer contracts and your relationships
- The way a prescription gets filled at the counter
- Final say on anything written off or appealed
- The ability to see every claim we touched
Before you ask
As far back as the payer still allows a claim to be reworked. Backlog clean-ups are taken on alongside ongoing billing, worked highest-value first, so current claims never stall while old ones are cleared.
A path that ends in a person. When a claim stops moving with a first-line representative it goes up, with the history attached, rather than being resubmitted into the same queue.
That is the point of categorising by cause. A denial that repeats is a process problem upstream, and it gets reported as one rather than reworked forever.
Yes. A backlog clean-up can run as a standalone engagement, though most pharmacies find the backlog rebuilds unless the daily cycle is covered too.
Works well alongside
Talk to us about your pharmacy
Send a month of remittances and we will show you what is being left behind before you commit to anything.