Claims Management
Claims Submitted This Month
342
+8.2% vs last month
First-Pass Acceptance Rate
94.2%
+1.8%
Average Days to Payment
18.4
Down from 22.1
Denial Rate
5.8%
Target: 3-5%
Outstanding AR
$47,230
2.3% of annual revenue
Net Collection Rate
97.1%
+0.4%
Claims Pipeline
Draft
14
Validation
8
Submitted
156
In Review
89
Paid
342
Denied
21
Appeal
7
| Claim # | Date | Patient | Provider | Procedure(s) | Insurance | Amount | Status | Days Open | Action | |
|---|---|---|---|---|---|---|---|---|---|---|
| CLM-2024-0501 | 02/01/2025 | Sarah Johnson | Dr. Michael Chen | D0150, D0210 | Delta Dental | $270.00 | Paid | 18 | ||
| CLM-2024-0502 | 02/02/2025 | John Martinez | Dr. Emily Rodriguez | D1110, D1120 | MetLife | $180.00 | Submitted | 16 | ||
| CLM-2024-0503 | 02/03/2025 | Emily Watson | Dr. Michael Chen | D2391 | Cigna | $185.00 | In Review | 14 | ||
| CLM-2024-0504 | 02/04/2025 | Robert Wilson | Dr. James Lee | D4341 | Aetna | $420.00 | Denied | 12 | ||
| CLM-2024-0505 | 02/05/2025 | Lisa Anderson | Dr. Emily Rodriguez | D2740 | Delta Dental | $950.00 | Paid | 11 | ||
| CLM-2024-0506 | 02/06/2025 | Michael Brown | Dr. Michael Chen | D7210 | MetLife | $550.00 | In Review | 9 | ||
| CLM-2024-0507 | 02/07/2025 | Jennifer Davis | Dr. James Lee | D1206 | Cigna | $60.00 | Submitted | 8 | ||
| CLM-2024-0508 | 02/08/2025 | David Taylor | Dr. Emily Rodriguez | D3110 | Aetna | $850.00 | Paid | 7 | ||
| CLM-2024-0509 | 02/09/2025 | Amanda White | Dr. Michael Chen | D2394 | Delta Dental | $280.00 | Draft | 5 | ||
| CLM-2024-0510 | 02/10/2025 | Daniel Garcia | Dr. James Lee | D0274 | MetLife | $220.00 | Denied | 4 | ||
| CLM-2024-0511 | 02/11/2025 | Patricia Lee | Dr. Emily Rodriguez | D4210 | Cigna | $700.00 | In Review | 3 | ||
| CLM-2024-0512 | 02/12/2025 | James Martin | Dr. Michael Chen | D2392 | Aetna | $350.00 | Submitted | 2 | ||
| CLM-2024-0513 | 02/13/2025 | Nancy Harris | Dr. James Lee | D1110 | Delta Dental | $100.00 | Submitted | 1 | ||
| CLM-2024-0514 | 02/14/2025 | Christopher Clark | Dr. Emily Rodriguez | D0150 | MetLife | $150.00 | Validation | 0 | ||
| CLM-2024-0515 | 02/15/2025 | Margaret Thomas | Dr. Michael Chen | D1120 | Cigna | $75.00 | Draft | 0 |
| Claim # | Patient | Insurance | Amount | Validation Status | Overall Score | Action |
|---|---|---|---|---|---|---|
| CLM-2024-0514 | Christopher Clark | MetLife | $150.00 |
Patient eligibility: Active
Subscriber ID: Verified
Pre-auth: Not required
CDT codes: Valid
Documentation: Complete
Timely filing: Within window
Duplicate check: No duplicates
|
Clean | |
| CLM-2024-0515 | Margaret Thomas | Cigna | $75.00 |
Patient eligibility: Active
Subscriber ID: Verified
Pre-auth: Required - Missing
CDT codes: Valid
Documentation: Complete
Timely filing: Within window
Duplicate check: No duplicates
|
Needs Review | |
| CLM-2024-0516 | Karen King | Delta Dental | $520.00 |
Patient eligibility: Active
Subscriber ID: Invalid
Pre-auth: Required - Missing
CDT codes: Invalid code D9999
Documentation: X-rays missing
Timely filing: Within window
Duplicate check: No duplicates
|
Blocked | |
| CLM-2024-0517 | Steven Wright | Aetna | $380.00 |
Patient eligibility: Active
Subscriber ID: Verified
Pre-auth: Not required
CDT codes: Valid
Documentation: Complete
Timely filing: Within window
Duplicate check: No duplicates
|
Clean | |
| CLM-2024-0518 | Linda Lopez | MetLife | $220.00 |
Patient eligibility: Active
Subscriber ID: Verified
Pre-auth: Required - Missing
CDT codes: Valid
Documentation: Narrative required
Timely filing: Within window
Duplicate check: No duplicates
|
Needs Review | |
| CLM-2024-0519 | Ronald Hall | Cigna | $640.00 |
Patient eligibility: Active
Subscriber ID: Verified
Pre-auth: Not required
CDT codes: Valid
Documentation: Complete
Timely filing: Within window
Duplicate check: No duplicates
|
Clean | |
| CLM-2024-0520 | Betty Young | Delta Dental | $310.00 |
Patient eligibility: Active
Subscriber ID: Verified
Pre-auth: Not required
CDT codes: Valid
Documentation: Complete
Timely filing: Within window
Duplicate check: No duplicates
|
Clean | |
| CLM-2024-0521 | Donald Allen | Aetna | $180.00 |
Patient eligibility: Terminated
Subscriber ID: Expired
Pre-auth: Not required
CDT codes: Valid
Documentation: Complete
Timely filing: Deadline passed
Duplicate check: No duplicates
|
Blocked |
Total Denials (MTD)
21
$8,420 at risk
Top Denial Reason
8
Missing Pre-Auth
Appeal Success Rate
72%
+5% improvement
Revenue at Risk
$8,420
5 claims pending
Denial Reasons Breakdown
Missing Pre-Auth: 38%
Eligibility: 24%
Coding Error: 18%
Documentation: 12%
Other: 8%
Denials by Insurance Payer
| Claim # | Patient | Procedure | Insurance | Denial Code | Reason | Amount | Days Since | Action |
|---|---|---|---|---|---|---|---|---|
| CLM-2024-0504 | Robert Wilson | D4341 | Aetna | CO-4 | Pre-authorization Required | $420.00 | 12 | |
| CLM-2024-0510 | Daniel Garcia | D0274 | MetLife | CO-29 | Service Not Covered | $220.00 | 4 | |
| CLM-2024-0525 | Kevin White | D2740 | Delta Dental | CO-197 | Pre-existing Condition | $950.00 | 8 | |
| CLM-2024-0530 | Susan Miller | D1120 | Cigna | PR-1 | Eligibility Issue | $75.00 | 6 | |
| CLM-2024-0535 | Paul Jackson | D3110 | MetLife | CO-16 | Incorrect Provider ID | $850.00 | 3 | |
| CLM-2024-0540 | Carol Davis | D4210 | Aetna | CO-4 | Pre-authorization Required | $700.00 | 15 | |
| CLM-2024-0545 | Joseph Moore | D2394 | Delta Dental | CO-29 | Service Not Covered | $280.00 | 9 | |
| CLM-2024-0550 | Anna Wilson | D7210 | Cigna | PR-1 | Eligibility Issue | $550.00 | 10 | |
| CLM-2024-0555 | George Young | D0150 | MetLife | CO-50 | Duplicate Claim | $150.00 | 2 | |
| CLM-2024-0560 | Helen Harris | D1206 | Delta Dental | CO-4 | Pre-authorization Required | $60.00 | 7 |
Pending Appeals (7)
| Claim # | Patient | Amount | Appeal Status | Days Remaining | Action |
|---|---|---|---|---|---|
| CLM-2024-0504 | Robert Wilson | $420.00 | Submitted | 23 | |
| CLM-2024-0525 | Kevin White | $950.00 | Under Review | 18 | |
| CLM-2024-0530 | Susan Miller | $75.00 | Drafted | 25 | |
| CLM-2024-0535 | Paul Jackson | $850.00 | Submitted | 29 | |
| CLM-2024-0540 | Carol Davis | $700.00 | Approved | 0 | |
| CLM-2024-0545 | Joseph Moore | $280.00 | Submitted | 20 | |
| CLM-2024-0550 | Anna Wilson | $550.00 | Under Review | 14 |
Payer Performance Scorecards
Delta Dental
Claims: 85 / Paid: 82 / Denied: 3
Avg Days to Pay: 16.2
Denial Rate: 3.5%
Reimbursement: 94.2%
Rating: A
MetLife
Claims: 72 / Paid: 67 / Denied: 5
Avg Days to Pay: 19.4
Denial Rate: 6.9%
Reimbursement: 91.3%
Rating: B
Cigna
Claims: 58 / Paid: 55 / Denied: 3
Avg Days to Pay: 17.8
Denial Rate: 5.2%
Reimbursement: 93.7%
Rating: A
Aetna
Claims: 45 / Paid: 42 / Denied: 3
Avg Days to Pay: 21.2
Denial Rate: 6.7%
Reimbursement: 88.9%
Rating: C
Guardian
Claims: 32 / Paid: 31 / Denied: 1
Avg Days to Pay: 15.6
Denial Rate: 3.1%
Reimbursement: 95.4%
Rating: A
BlueCross
Claims: 28 / Paid: 26 / Denied: 2
Avg Days to Pay: 18.9
Denial Rate: 7.1%
Reimbursement: 92.1%
Rating: B
Fee Schedule Comparison
| CDT Code | Description | Your Fee | Delta Allowed | MetLife Allowed | Cigna Allowed | Avg Write-off |
|---|---|---|---|---|---|---|
| D0120 | Periodic Oral Exam | $75.00 | $60.00 | $55.00 | $58.00 | 22.0% |
| D0150 | Comprehensive Exam - New | $150.00 | $120.00 | $110.00 | $115.00 | 24.0% |
| D0210 | Full Mouth X-Ray | $120.00 | $96.00 | $88.00 | $92.00 | 24.0% |
| D0274 | Bitewings - Four | $85.00 | $68.00 | $62.00 | $65.00 | 24.0% |
| D1110 | Prophylaxis - Adult | $100.00 | $80.00 | $75.00 | $78.00 | 21.0% |
| D1120 | Prophylaxis - Child | $85.00 | $68.00 | $63.00 | $66.00 | 21.0% |
| D2391 | Composite - One Surface | $180.00 | $144.00 | $132.00 | $138.00 | 24.0% |
| D2740 | Crown - Porcelain/Ceramic | $1,200.00 | $900.00 | $825.00 | $870.00 | 28.0% |
| D4341 | Periodontal Scaling - Per Quad | $175.00 | $140.00 | $128.00 | $135.00 | 22.3% |
| D7210 | Extraction - Surgical | $320.00 | $256.00 | $235.00 | $248.00 | 22.5% |
$23,100
48.9% of AR
Current (0-30 days)
$12,400
26.2% of AR
31-60 days
$7,200
15.2% of AR
61-90 days
$4,530
9.6% of AR
90+ days
Gross Collection Rate
98.2%
Target: 97%+
Net Collection Rate
97.1%
+0.4%
Average Days in AR
24.3
Target: <20 days
AR Over 90 Days
9.6%
Target: <10%
Aging Detail
| Patient | Insurance | Claim # | Date of Service | Amount | Days Outstanding | Last Follow-up | Status | Action |
|---|---|---|---|---|---|---|---|---|
| James Martin | Aetna | CLM-2024-0512 | 02/12/2025 | $350.00 | 2 | 02/16/2025 | Pending | |
| Nancy Harris | Delta Dental | CLM-2024-0513 | 02/13/2025 | $100.00 | 1 | — | Pending | |
| Patricia Lee | Cigna | CLM-2024-0511 | 02/11/2025 | $700.00 | 3 | 02/15/2025 | In Review | |
| Daniel Garcia | MetLife | CLM-2024-0510 | 02/10/2025 | $220.00 | 4 | 02/14/2025 | Denied | |
| Michael Brown | MetLife | CLM-2024-0506 | 02/06/2025 | $550.00 | 9 | 02/12/2025 | In Review | |
| David Taylor | Aetna | CLM-2024-0508 | 02/08/2025 | $850.00 | 7 | 02/10/2025 | Pending | |
| Jennifer Davis | Cigna | CLM-2024-0507 | 02/07/2025 | $60.00 | 8 | 02/11/2025 | Pending | |
| Lisa Anderson | Delta Dental | CLM-2024-0505 | 02/05/2025 | $950.00 | 11 | 02/09/2025 | Paid | |
| Robert Wilson | Aetna | CLM-2024-0504 | 02/04/2025 | $420.00 | 12 | 02/08/2025 | Appeal | |
| Emily Watson | Cigna | CLM-2024-0503 | 02/03/2025 | $185.00 | 14 | 02/05/2025 | In Review | |
| John Martinez | MetLife | CLM-2024-0502 | 02/02/2025 | $180.00 | 16 | 02/04/2025 | Pending | |
| Sarah Johnson | Delta Dental | CLM-2024-0501 | 02/01/2025 | $270.00 | 18 | 02/02/2025 | Paid |
Unprocessed ERA Queue
| Payer | Date Received | Claims | Total Amount | Status | Action |
|---|---|---|---|---|---|
| Delta Dental | 02/16/2025 | 12 | $3,450.00 | New | |
| MetLife | 02/15/2025 | 8 | $2,120.00 | New | |
| Cigna | 02/14/2025 | 6 | $1,780.00 | New | |
| Aetna | 02/13/2025 | 5 | $1,350.00 | New | |
| Guardian | 02/12/2025 | 4 | $980.00 | New |
Processed ERA History (Last 20)
| Date Processed | Payer | Claims | Total Paid | Adjustments | Patient Resp | Posted By | Status |
|---|---|---|---|---|---|---|---|
| 02/15/2025 | Delta Dental | 15 | $4,200.00 | -$180.00 | $620.00 | Sarah M. | Complete |
| 02/14/2025 | MetLife | 11 | $3,100.00 | -$250.00 | $480.00 | Jennifer K. | Complete |
| 02/13/2025 | Cigna | 9 | $2,450.00 | -$120.00 | $380.00 | Sarah M. | Complete |
| 02/12/2025 | Aetna | 7 | $1,980.00 | -$90.00 | $320.00 | Mark T. | Complete |
| 02/11/2025 | Delta Dental | 14 | $3,950.00 | -$210.00 | $590.00 | Jennifer K. | Complete |
| 02/10/2025 | Guardian | 6 | $1,620.00 | -$75.00 | $245.00 | Sarah M. | Complete |
| 02/09/2025 | MetLife | 10 | $2,850.00 | -$140.00 | $425.00 | Mark T. | Complete |
| 02/08/2025 | Cigna | 8 | $2,240.00 | -$105.00 | $350.00 | Jennifer K. | Complete |
| 02/07/2025 | Aetna | 6 | $1,680.00 | -$80.00 | $280.00 | Sarah M. | Complete |
| 02/06/2025 | Delta Dental | 13 | $3,650.00 | -$195.00 | $550.00 | Mark T. | Complete |
| 02/05/2025 | BlueCross | 5 | $1,430.00 | -$70.00 | $215.00 | Jennifer K. | Complete |
| 02/04/2025 | MetLife | 9 | $2,700.00 | -$135.00 | $410.00 | Sarah M. | Complete |
| 02/03/2025 | Cigna | 7 | $2,100.00 | -$100.00 | $330.00 | Mark T. | Complete |
| 02/02/2025 | Aetna | 5 | $1,550.00 | -$60.00 | $260.00 | Jennifer K. | Complete |
| 02/01/2025 | Delta Dental | 12 | $3,400.00 | -$170.00 | $510.00 | Sarah M. | Complete |