1. Key Metrics to Analyze
✔ Aging Buckets – Focus on 60+ day claims first
✔ Payer Trends – Identify slow processors (e.g., Medicaid vs. commercial)
✔ Denial Reasons – Target high-frequency issues (e.g., CO-29 medical necessity)
✔ Provider Patterns – Flag clinicians with high denial rates
2. Prioritization Strategy
| Priority | Claims to Target | Action |
| High | >$1,000 + 60+ days | Escalate to payer rep + appeal |
| Medium | 500−500−1,000 + 45+ days | Phone follow-up + documentation |
| Low | <$500 + <30 days | Automated reminders |
3. Tools for Efficiency
✔ RCM Dashboards – Visualize aging/denial trends
✔ AI Predictions – Flag claims likely to deny
✔ Automated Worklists – Assign follow-ups by priority
4. Pro Tips
- Daily: Review new denials
- Weekly: Audit 10% of aging claims
- Monthly: Train staff on top denial causes
