An ABA Organization's 120+ Day A/R Hit $623,000. Most of It Was Recoverable. We Proved It.
Table of Contents
THE SITUATION
This ABA organization had expanded from 1 to 4 locations over 18 months. The billing team scaled from 1 to 3 people but not fast enough. New claim volume was absorbing 100% of billing capacity.
Nobody was working aged A/R. By October 2024, the 120+ day bucket was $623,000 across three states and four payers. Florida Medicaid claims had timely filing windows that were expiring.
The organization had 60 days to act before a large portion would be permanently uncollectible.
WHAT WAS ACTUALLY WRONG
FL and GA Medicaid claims were aging past 12-month timely filing limits:
Florida Medicaid has a 12-month timely filing limit from date of service. Georgia Medicaid is 12 months from date of service as well. $178,000 in claims were within 45 days of the limit no one had prioritized them.
Authorization documentation wasn’t attached to aged Aetna claims:
$147,000 in Aetna claims had originally been denied for missing authorization documentation. The authorizations existed in CentralReach. Nobody had attached them and resubmitted. Claims had been sitting denied for 4–6 months.
Cigna claims had wrong service location codes for multi-site billing:
The organization billed from 4 locations. Cigna requires unique billing location NPIs for each site. Two locations were billing under the primary location NPI. Cigna had been denying the provider location mismatch for 8 months.
WHAT WE DID
Days 1–5: Emergency triage. Sorted all $623,000 by state, payer, filing window, and denial reason. FL and GA Medicaid claims prioritized all submitted within 10 days.
Days 5–15: Pulled all authorization documentation from CentralReach for Aetna denials. Attached to corrected claims and resubmitted all $147,000 within 2 weeks.
Weeks 3–4: Registered separate billing location NPIs for the 2 Cigna-affected sites. Resubmitted all Cigna location-mismatch denials with correct NPIs.
Weeks 5–12: Worked remaining A/R by payer direct provider relations escalation for claims over 90 days with no activity, formal appeal process for denied claims with documentation.
Week 13: $521,000 collected. $102,000 remaining in active dispute or pending payment.
THE RESULTS
| Metric | Before | After |
|---|---|---|
| 120+ Day A/R | $623,000 | $102,000 remaining |
| Revenue Recovered | — | $521,000 |
| Claims Lost to Timely Filing | Projected $178,000 | $0 |
| Aetna Auth-Denial Recovery | $0 | $147,000 |
| Cigna Location Fix Recovery | $0 | $89,000 |
WHAT THIS MEANS FOR YOUR PRACTICE
ABA multi‑state A/R is squeezed by different Medicaid timely filing windows, multi‑location NPI rules, and heavy auth documentation. When teams focus only on new claims, aged A/R stalls and with 12‑month Medicaid windows, inaction hits a hard deadline. The sooner you engage, the more you recover.