What Is an AR Review in Medical Billing — And Why It Should Happen Monthly

If you run a medical practice, there's a good chance money is sitting in your accounts receivable right now that should have been collected weeks ago. Not because your payers won't pay — but because no one followed up.

That's the problem an AR review solves.

What Is an AR Review?

An AR (accounts receivable) review is a structured, systematic analysis of all unpaid claims across your insurance payers. The goal is simple: identify what's owed, understand why it hasn't been paid, and take action to collect it.

Done right, an AR review isn't just a report. It's a working session where someone logs directly into payer portals — like Availity, Noridian, and Waystar — checks claim status in real time, and makes decisions about what to work first.

The 30/60/90/120 Framework

AR is typically broken into aging buckets based on how long a claim has been outstanding:

• 0–30 days: Normal processing time for most payers. These generally don't need action yet.
• 31–60 days: Watch closely. If a claim hasn't posted, it may need a status check.
• 61–90 days: Requires active follow-up. Call the payer, check the portal, confirm receipt.
• 91–120 days: Urgent. Denials in this range are often harder to overturn. Work these immediately.
• 120+ days: Critical. Many payers have timely filing limits. Claims past this threshold may be uncollectible.

The goal of a monthly AR review is to prevent claims from aging past 90 days. Once a claim crosses that threshold, your collection odds drop significantly.

What Happens During a Real AR Review

A thorough AR review involves several steps:

1. Pull the Service Item (SI) Report

The SI report breaks down every service billed by CPT code, provider, date of service, and payer. This gives you a complete picture of what was billed versus what was paid — and flags underpayments, denials, and zero-pays at a procedure level.

2. Check Claim Status in Availity

Availity is the nation's largest multi-payer portal, covering over 2,000 payers. Your biller logs in, pulls claim status across Blue Cross, Aetna, Cigna, UHC, and others — without logging into each payer separately. Outstanding claims are immediately visible with denial reason codes if applicable.

3. Work Medicare Claims in Noridian

For practices in California and other Western states, Medicare Part B claims are administered by Noridian (Jurisdiction E and F). The Noridian Medicare Portal (NMP) shows claim status, remittance details, and allows billers to initiate redeterminations (first-level appeals) directly in the portal. If Medicare denied a claim, this is where you go to appeal it.

4. Identify Pattern Denials in Waystar

Waystar is a clearinghouse that processes claims from submission to payment. One of its most powerful features is denial analytics — it can identify which payers are repeatedly denying specific CPT codes, flag claims that didn't transmit correctly, and surface systemic billing issues before they multiply.

5. Prioritize and Work the Queue

With a consolidated view from all portals, the AR team prioritizes by dollar amount and aging bucket, then works through the queue: calling payers, submitting appeals, requesting reconsiderations, or writing off legitimate adjustments.

Why Monthly Is the Minimum

Most practices that struggle with cash flow aren't billing the wrong codes — they're not following up consistently. Here's what slipping from monthly to quarterly AR reviews costs you:

• Claims age past timely filing limits and become uncollectible
• Denied claims go unappealed because the 90-day appeal window closes
• Payer underpayments go unnoticed because no one compared contracted rates to EOBs
• Your AR days outstanding (ARDO) creeps up, distorting your actual financial picture

The industry benchmark for ARDO is under 40 days for high-performing practices. Many practices we take on are sitting at 65–90 days when they first come to us — and a significant portion of that is recoverable with aggressive AR work.

Signs Your AR Review Isn't Happening Often Enough

• You have claims older than 90 days that haven't been touched
• Your denial rate is over 5–7%
• You're writing off denials instead of appealing them
• You don't know your current clean claim rate
• You've never seen a Service Item Report

What a Good AR Review Looks Like at Medbillytics

When we perform AR reviews for our clients, we:

1. Pull the full SI report by payer, CPT code, and date of service
2. Log into Availity and check status for all commercial payer claims
3. Work Medicare/Medicaid claims directly in Noridian and the relevant state MAC portal
4. Use Waystar to identify systemic denial patterns and fix the upstream billing rule
5. Consolidate all outstanding balances into a single report with action items and dollar totals
6. Deliver a monthly AR dashboard showing what was worked, what was collected, and what's still pending

The result is a practice that never has to wonder where its money is.

---

Ready to see what's sitting in your AR right now? Get a free assessment — we'll pull your aging report and show you exactly what's collectible.