Module 7.1

A/R Command Engine

When A/R gets reported as a single balance, it hides critical details about what is recoverable, what is not, and what is at risk. Claims nearing the timely filing deadline fall through the cracks, and no one notices. Revenue you should have earned becomes a write-off that should have been avoidable. Payer issues hide because no one looks at them individually. Your days in A/R creeps up, but it is within the benchmark for your specialty, so you don't spend too much time thinking about it. Something feels off. The A/R Command Engine gives you the visibility you need to stop issues before they become catastrophic.

The A/R Command Engine shows you exactly where every dollar sits and which claims risk missing timely filing deadlines. It ingests your claim data and your remittance data, so the aging reflects what is genuinely outstanding after every payment, adjustment, and denial has been accounted for. Your team gets a clear, prioritized worklist every morning. Your leadership gets a live view of aging, payer performance, first-pass resolution, and at-risk dollars, all in one place.

For technical details: View technical documentation

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How It Works

Four Steps from Raw Claims to a Prioritized Worklist

The engine reads your claims and payments data, sorts every open dollar by age, checks each claim against the payer's timely filing limit, and hands your team a clear list of what to work first. No spreadsheets, no guesswork.

1
Ingests, processes, and analyzes claims and remittance data
The engine pulls your open and submitted claims data, plus your remittance files. It matches every claim against any payments, adjustments, and denials. The result is aging data that is accurate, timely, and actionable. Direct 837 and 835 ingestion is supported alongside practice-management system feeds.
2
A/R is organized into aging buckets
Every open claim is placed into an aging bucket. You can see the dollar total and claim count in each bucket at a glance.
3
Automated timely filing comparison flags “At Risk” claims
Timely filing deadlines vary by payer. This engine pulls from a payer database that is constantly updated to calculate how many days each claim has until the payer's timely filing deadline. Since payers are grouped by their high-level group (for example, BCBS IL and BCBS MD roll up to BCBS), there may be multiple deadlines inside that group. You choose how the engine flags risk: Conservative mode applies the tightest limit in the group, Average mode uses the mean. Most practices run Conservative.
4
Sorts your worklist by what to work first
Claims with the highest dollar value and fewest days before their timely filing limit rise to the top. Your team sees the most urgent claims first, with the dollar amount and the action needed right next to each one.
Your Output
Aging Dashboard
Timely Filing Worklist
Payer Summary
At-Risk Report
First-Pass Resolution
Denial Mix
Sample Output

A/R Command Dashboard

A sample run for a pediatric practice. Every number reflects what the engine actually produces: aging buckets, at-risk claims against timely filing limits, and a payer-by-payer breakdown of where your money sits.

Practice Type: Pediatrics Open Claims: 1,040 Total A/R: $187,432
Total A/R
$187,432
All open claims
Tracked
0–30 Days
$89,967
48% of total A/R
Healthy
90+ Days
$24,153
13% of total A/R
Needs attention
At-Risk vs. Timely Filing Limit
$18,200
47 claims at risk
Act now
First-Pass Resolution
82%
Claims paid on first submission
Above benchmark
Denial Mix
Top 5
Reason codes driving denied dollars
See breakdown
Aging Buckets

Each bucket shows the total dollars and percentage of your A/R in that age range. Green is healthy. Red means those dollars are in serious jeopardy.

0–30 Days
$89,967
48% of A/R
Healthy. Work normally.
31–60 Days
$43,800
23% of A/R
Monitor. Follow up soon.
61–90 Days
$29,512
16% of A/R
Watch. Escalate stale claims.
91–120 Days
$18,750
10% of A/R
Escalate. File or appeal now.
120+ Days
$5,403
3% of A/R
Write-off review required.
At-Risk Against Timely Filing Limits

These claims are the most urgent in your A/R. Each payer has its own filing deadline. When that window closes, the claim is gone. The Days Left column tells your team exactly how much time they have.

Patient Payer TFL Days Filed Days Left Claim $ Status
Sarah Chen Aetna (HMO) 120 days 108 12 $1,250 Urgent
Carlos Torres UHC Commercial 90 days 82 8 $480 Urgent
Thanh Nguyen Medicaid 90 days 78 12 $320 Urgent
Angela Williams BCBS Florida 360 days 320 40 $1,500 Watch
Robert Chen Medicare 365 days 340 25 $185 Watch
Urgent: file or appeal immediately Watch: within 60-day window On Track: plenty of time remaining
Top Payers by A/R

Each payer's share of your open A/R, their timely filing limit, the average age of their claims, and how many are currently at risk. Payers with a short TFL and a high average age deserve the most attention.

Payer TFL Days Claims in A/R Total $ Avg Days At-Risk
Aetna 120 23 $14,200 67 3
BCBS 60–365 47 $28,400 84 8
UHC 90 31 $18,950 71 5
Cigna 90 18 $9,840 58 2
Medicare 365 22 $11,820 92 1

BCBS Timely Filing Limit ranges from 60 days (Blue Shield High Mark, Keystone) to 365 days (Blue Cross PPO, Blue Shield). The engine applies the conservative limit per plan when known, and the 60-day floor when not.

Revenue Cycle Overview

Jan 1 – Dec 31, 2025 · 9,970 claims

A full-year operational view to pair with the daily worklist. The same engine that drives aging and timely filing risk also produces these leadership-level views.

Total billed
$2.54M
9,970 claims · 365 days
Net collection rate
78.8%
Target 95% or higher
Denial rate
13.6%
Industry average 10–15%
Median charge lag
3 days
Service date to submission
Days in A/R
49
Target under 40
A/R over 90 days
50%
Target under 15%
Monthly Billed vs Collected
Billed Collected
$250K $190K $130K $70K $0 JanFebMarAprMayJunJulAugSepOctNovDec
A/R Aging (Full Year)

$337K outstanding · 50% over 90 days

$128K
0–30
$20K
31–60
$21K
61–90
$17K
91–120
$151K
120+
Payer Mix

Share of billed charges

  • Medicare Part B · 21%
  • BCBS · 19%
  • Aetna · 15%
  • UnitedHealthcare · 14%
  • Medicaid · 8%
  • Cigna · 8%
  • +6 more · 15%
Claims Pipeline

Visit-to-paid funnel with conversion at each stage

Scheduled visits
12,352
—
Completed visits
10,487
85%
Claims submitted
9,970
95%
Clearinghouse accepted
9,616
96%
Adjudicated by payer
9,072
94%
Paid
7,837
86%
Top Denial Reasons by Financial Impact

CARC code, denial description, claim count, total dollar value

50
Non-covered services — not deemed medical necessity
596 clms
$107K
16
Claim or service lacks information needed for adjudication
376 clms
$72K
197
Precertification or authorization absent
219 clms
$37K
109
Claim not covered by this payer
167 clms
$30K
29
Time limit for filing has expired
151 clms
$26K
27
Expenses incurred after coverage terminated
153 clms
$26K
97
Benefit included in payment for another procedure
86 clms
$16K
18
Exact duplicate claim or service
73 clms
$13K
Charge Lag Distribution

Days from date of service to claim submission

1,911
Same day
3,788
2–3 days
3,048
4–7 days
508
8–14 days
552
15–30 days
163
31+ days
517
Unbilled

Fictitious patient names for illustration. Payer Timely Filing Limit values are sourced from published payer policy documents. Your actual Timely Filing Limit windows may vary by contract, plan type, and state. Verify directly with each payer for your specific agreements.

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