What slows your A/R: unpaid insurance claims and missed follow-up
Fastora’s accounts receivable management services give your practice steady, documented follow-up on every open balance, from the day a claim is sent until it is paid or closed. Certified medical billing professionals work inside your existing EHR/PM system and combine insurance follow-up services, appeals and patient balance work into one routine. It is part of our wider medical billing services, and it can also be set up on its own.
Unpaid insurance claims rarely stall for a single reason. The usual causes are:
- Clearinghouse rejections that were never corrected, so the payer never received the claim.
- Claims pended for medical records, coordination of benefits details or an accident questionnaire that nobody sent.
- Denials posted as zero payments and never reviewed.
- Underpayments accepted without comparing them with the contracted rate.
- No one assigned to call the payer once a claim passes 30 days.
Each of these shows up as money sitting in aging buckets. Insurance payment follow-up closes the gap between a claim being sent and a claim being paid correctly.
Our A/R follow-up process: AR management and insurance follow-up
Medical billing AR follow-up is a daily routine rather than a month-end scramble. Each claim moves through the same steps, and each step leaves a note in your system.
- Check status: send electronic claim status inquiries using the HIPAA standard 276/277 transactions, where the payer supports them, and use payer portals or phone calls when the response is vague.
- Find the blocker: a missing record, a coordination of benefits question, a rejected claim that never reached the payer, or a denial posted with no payment.
- Act: send the requested records, correct and resubmit the claim, or route the denial for an appeal.
- Verify payment: compare the paid amount with the contracted rate when the remittance posts.
- Close or escalate: close paid claims, escalate stalled ones, and recommend a write-off only under the policy you approve.
Insurance AR follow-up often turns up problems that sit outside billing. A run of denials for one new provider, for example, usually means payer enrollment is not finished, and those claims are held until provider credentialing and enrollment is complete rather than resubmitted into the same denial.
Write-off policy
Balances should only be adjusted for a documented reason that matches your write-off policy, such as an expired filing limit with no proof of timely filing or a contractual adjustment. We list each recommended adjustment with the reason code and supporting notes, and nothing is written off without your approval.
Aging buckets we prioritize for insurance claim follow-up
Our AR follow-up services work the aging report bucket by bucket, so effort goes where the risk is. The table shows what happens at each stage; timing adjusts to each payer’s processing and filing rules.
| Aging bucket | What we do |
|---|---|
| 0–30 days (30-day AR) | Confirm the clearinghouse accepted the claim and the payer received it; fix rejections in the same cycle; post payments and flag denials as remittances arrive. |
| 31–60 days (60-day AR) | Check claim status on payer portals or by phone; send requested records or coordination of benefits updates; correct and resubmit denied claims. |
| 61–90 days (90-day AR) | Escalate claims with no payer response; appeal denials that a correction did not resolve; compare paid lines with contracted rates. |
| 91–120 days (120-day AR) | Prioritize by filing and appeal deadlines; request supervisor or provider relations help on stuck claims; document every contact. |
| 120+ days | Decide claim by claim whether to appeal further, bill a secondary payer, transfer the balance to the patient, or recommend an adjustment, and report what remains and why. |
Unpaid claims follow-up is logged with the date, the payer representative, the call reference number and the next step, so anyone on the team can pick up a claim without repeating work. Within each bucket, claims are ordered by time left before the payer’s filing or appeal deadline, then by balance, so a smaller claim about to expire is not buried under larger ones. The same rules apply to unpaid insurance claims follow-up on claims a previous biller left open.
Old A/R and AR backlog work
A medical billing takeover usually comes with an AR backlog: aged claims the previous biller or in-house team never finished. That backlog needs a different approach from routine follow-up, because each old claim needs research before anyone calls a payer.
We handle it as a separate backlog project: we inventory the backlog, triage it by payer deadline, and close out what cannot be collected, while ongoing follow-up keeps current claims on track.
Recovery on legacy balances depends on what documentation still exists, so progress is reported plainly, including balances that are no longer collectible. For claims that have aged well past timely filing windows, see our aged AR recovery services.
Timely filing management
Timely filing management means knowing each payer’s deadline and working to it. Medicare generally requires claims to be filed within 12 months of the date of service under 42 CFR 424.44, with limited exceptions. Commercial and Medicaid deadlines vary by contract and state and are often shorter, so we keep payer-specific filing limits for each account and check them against your contracts.
Proof of timely filing matters too. We keep clearinghouse acceptance reports and payer acknowledgments, so if a payer later says a claim was never received, there is a record that it was filed on time.
Payer escalation and appeals
When a claim stalls, we escalate in steps: a reprocessing request by phone, then a written reconsideration, then a formal appeal if the payer upholds its decision. Denials found during follow-up go to our denial management team, which handles appeals and fixes the root cause.
Paid claims that do not match the contracted rate are flagged and pursued through underpayment recovery, so short payments are not written off by default.
Reporting that helps reduce days in AR
You receive an A/R aging report every month, broken down by payer and bucket, as part of Fastora’s monthly performance reporting and review call. Transparent dashboards show progress between calls, and custom reports are available on request. AR days and the share of balances over 90 days are reviewed with you on every call.
How days in A/R is calculated
Days in A/R is total accounts receivable divided by average daily charges, often averaged over the last three to six months. A rising figure means claims are taking longer to pay, even if collections look steady. Viewing it by payer shows whether one plan, rather than the whole process, is driving the change. Check yours with our days in AR calculator.
- Total AR and the share in each aging bucket, by payer
- Days in AR, trended month over month
- Claims at risk of missing a filing deadline, with next actions
- Legacy AR worked, collected and closed out
For definitions and examples, see our explainer on how AR aging buckets work.
Getting started
Every engagement begins with a free claims audit of your current A/R before you commit to anything. After that, the work is ongoing A/R management: claim status checks, appeals and follow-up by payer and age. The audit shows how your balances are spread across payers and aging buckets and which older claims are still inside payer deadlines.
From there, your dedicated account contact agrees the follow-up priorities with you. We work inside your existing EHR/PM system, with no hidden setup fees and no software to install, and every workflow is aligned with HIPAA and HITECH, with encryption, strict access controls and regular internal audits. Fees are quoted after the assessment, and you can see how our pricing models work before that conversation.
An AR follow-up company for aging claims
Fastora works as an AR follow up company for practices whose own staff cannot keep up with the aging report: every claim over 30, 60, 90, and 120 days worked on a fixed weekly rhythm — status checked, corrected, appealed, or escalated — with timely filing limits flagged before they expire. The routine is the service. Claims do not age because someone forgot them; they age because follow-up is the work that gets dropped first, so we make it the work that happens on schedule. For claims already past 120 days, see our old A/R recovery service, our denial management service fixes the denial root causes, read how to reduce days in A/R.