$410,000 Sitting in 90+ Day A/R. A Tennessee SUD Center Got $352,000 of It Back in 4 Months.
Table of Contents
THE SITUATION
This SUD treatment center had been operating for five years. They ran a solid clinical program, strong admissions, consistent census, and good outcomes. Their billing was handled by a two-person in-house team.
In Q3 2023, their CFO pulled an A/R aging report for the first time in eight months. The 90+ day bucket was $410,000. Claims were going out. Some payments were coming in. But a growing pile of older claims had no activity, no follow-up notes, and no escalation.
The billing team was keeping up with new claims. Nobody was working the back end.
At their current trajectory, an estimated $160,000 of the aging A/R would cross the timely filing limits within 60 days and become permanently uncollectible. They called us the same week.
WHAT WAS ACTUALLY WRONG
We ran a full A/R aging analysis in the first 72 hours. Every claim in the 90+ day bucket was categorized by payer, denial code, last activity date, and remaining filing window.
No follow-up system existed for claims past 45 days. The billing team sent claims and posted payments. If a claim wasn’t paid, it sat until a provider asked about it. Aetna and Cigna both have a 90-day follow-up requirement to keep claims active. Hundreds of claims had gone cold.
TennCare Medicaid claims were failing on ASAM documentation. Tennessee Medicaid requires ASAM level-of-care documentation attached to SUD claims at specific intervals. The clinical team was completing documentation, but it wasn’t being attached to billing. TennCare was denying on receipt with a documentation-not-submitted code. The billing team didn’t recognize the denial reason.
Write-off decisions were being made without payer appeals. Three months of denials had been moved to write-off status by the billing coordinator without filing a single formal appeal. Some of those denials had strong appeal grounds. The revenue was being surrendered without a fight.
WHAT WE DID
Days 1–5: Triage. Sorted all $410,000 by filing window urgency. Identified $287,000 in claims still within filing or appeal windows. Built a priority work queue oldest actionable claims first.
Week 2: Contacted TennCare provider relations. Confirmed the ASAM documentation requirement and the correct attachment process in Kipu. Retroactively attached documentation to 90 days of denied claims and resubmitted. TennCare began approving within 3 weeks.
Weeks 3–6: Worked Aetna and Cigna, aging systematically direct payer calls on claims over 60 days, escalation to provider relations for claims showing no adjudication activity. Filed formal appeals on $74,000 in previously written-off denials with supporting clinical documentation.
Week 7 onward: Built a 45-day follow-up workflow inside Kipu automated task triggers for any claim with no activity at 45 days. The in-house billing team was trained on the new queue management process.
THE RESULTS
| Metric | Before | After (4 Months) |
|---|---|---|
| 90+ Day A/R Balance | $410,000 | $58,000 |
| Revenue Recovered | — | $352,000 |
| Write-off Appeals Won | $0 | $61,000 |
| Monthly Cash Flow | Baseline | +43% |
| Claims Lost to Timely Filing | Projected $160K | $0 |
TennCare approved $143,000 in resubmitted claims once documentation was correctly attached. Aetna and Cigna paid $148,000 through systematic follow-up. Appeals recovered $61,000 from claims the practice had already written off.
Recover Revenue Before It’s Lost!
Accounts over 90 days often become aged from inaction, not denials. We prioritize timely follow-up and deadline management so you recover more revenue before claims become legally uncollectible.