This guide explains why claims that are neither paid nor denied, just pending or silently aging, are a distinct problem from active denials, since nothing in a standard workflow prompts follow-up automatically. It covers AR aging buckets and the HFMA benchmark recommending claims past 90 days stay below 10% of total receivables, and corrects a common misconception: timely filing deadlines are contract-specific, not a general 120-day assumption, meaning practices often write off genuinely recoverable claims prematurely. Industry data shows unstructured AR cleanup recovers roughly 20 cents on the dollar compared to 60 cents with systematic, prioritized follow-up, a threefold difference driven by process. SPRY's real-time billing dashboard tracks every claim's status from submission to payment, connected to the same platform handling denial management and underpayment detection, so no claim sits unworked without a defined next action.
Why Would a Submitted Claim Just Sit There With No Status Update?
Because nothing in a standard billing workflow forces a next action unless a claim is explicitly denied. A claim that's neither paid nor denied, just pending, delayed, or stuck in payer processing, doesn't generate the same urgency a rejection does, which means it can age for weeks without anyone actively working it. SPRY's real-time billing dashboard gives a real-time view of every claim's status, from submission to payment, so a pending claim doesn't disappear into a queue nobody is watching.
What's the Difference Between a Denied Claim and a Claim That's Just Sitting?
These are two distinct problems, and conflating them means the wrong process gets applied to each.
A denied claim has a clear next step because the payer told you what's wrong. A silent claim has no such prompt, it just needs someone to notice it hasn't moved and check.
How AR Aging Actually Reveals This Problem
Accounts receivable aging is typically organized into buckets, and each one signals a different level of risk.
Source: Neolytix, "Accounts Receivable in Medical Billing: What It Is and How to Manage It," see references
HFMA guidelines recommend keeping AR over 90 days below 10% of total receivables. A practice with a significantly higher share sitting in that bucket has a follow-up gap, not necessarily a denial problem, since these are largely claims nobody actively worked before they aged this far.
The Myth That Causes Practices to Write Off Recoverable Claims
One specific misconception makes silent claim gaps worse than they need to be: assuming a claim past 120 days is automatically gone. It usually isn't. Timely filing deadlines vary significantly by payer and are set by the actual contract, not a general assumption. Medicare allows 12 months from the date of service. Medicaid varies by state, anywhere from 90 days to 24 months. Most commercial payers set filing windows between 90 and 180 days, but the specific contract with that payer is what actually controls, not the payer's general published policy.
A claim sitting at 135 days might still be well within its actual filing window depending on the payer. Practices that skip verifying this and write off every claim once an aging bucket turns red are abandoning genuinely recoverable revenue based on an assumption, not a confirmed deadline.
What Poor Follow-Up Actually Costs, Compared to Good Follow-Up
The gap between reactive and systematic claim follow-up shows up directly in recovery rates. Industry data on AR cleanup efforts found that unstructured recovery attempts typically recover around 20 cents on the dollar, when a systematic, prioritized approach recovers closer to 60 cents on the dollar, a 3x difference driven entirely by process, not by which claims happened to be recoverable in the first place.
Separately, 65% of recoverable denied claims are never reworked at all, according to industry data, with that revenue accumulating in aging AR until it's written off as a permanent, avoidable loss. Silent, unworked claims follow the same pattern for an even less visible reason, since a denial at least prompts someone to look.
What to Look for in Software That Prevents This
Does it show real-time claim status, not just a submitted/paid binary?
A dashboard that only shows "submitted" and "paid" hides everything happening in between, which is exactly where claims go silent.
Does it prioritize claims by payer deadline and dollar value, not just by age?
The oldest claim isn't always the most at-risk claim. A lower-dollar claim approaching its filing deadline needs attention before an older, higher-dollar claim still well within its window.
Does it assign a defined next action and follow-up date to every open claim?
A claim without a scheduled next check is a claim that can silently age past its deadline with nobody responsible for noticing.
Does it flag claims specifically as they approach their timely filing deadline, not after?
Follow-up initiated close to a payer's deadline, rather than well before it, leaves little room to actually recover a claim that's stuck.
How SPRY Prevents Claims From Going Silent
This connects directly to SPRY's denial management workflow, where every denial is tracked and worked within 1 to 2 days, and to the same underpayment detection covering the other silent revenue gap that doesn't show up as a denial at all.
Claim Follow-Up Audit Checklist
- Pull a current AR aging report and check what percentage sits past 90 days against the HFMA 10% benchmark
- Before writing off any claim past 120 days, confirm the actual contracted timely filing deadline for that specific payer
- Review whether every open claim has a defined next action and follow-up date, not just a status
- Check whether follow-up is prioritized by payer deadline and dollar value, not simply claim age
- Confirm denials are being worked within a defined response window, not left in a general queue
- Audit a sample of claims marked "pending" for more than 30 days to confirm they're actually still active with the payer
- Track recovery rate on aged claims over time to see whether follow-up process, not claim validity, is the limiting factor
Frequently Asked Questions
How long can a claim sit before it's actually unrecoverable?
It depends entirely on the specific payer contract, not a general rule. Medicare allows 12 months, Medicaid varies by state from 90 days to 24 months, and most commercial payers set 90 to 180 day windows, though the actual contract terms control over general published policy.
What percentage of AR should be older than 90 days?
HFMA guidelines recommend keeping claims aged past 90 days below 10% of total accounts receivable. A higher share generally signals a follow-up process gap.
Is a pending claim the same as a denied claim?
No. A denial is an active rejection that generates a reason code and a clear next step. A pending or silent claim has received no definitive response and requires someone to proactively check status, since nothing prompts action automatically.
How much of a difference does structured follow-up actually make?
Industry data suggests unstructured AR cleanup recovers around 20 cents on the dollar, while systematic, prioritized follow-up recovers closer to 60 cents on the dollar, a threefold difference driven by process rather than claim quality.
Should claims be prioritized by age or by dollar value?
Neither alone. Effective prioritization weighs balance size, aging relative to the payer's actual filing deadline, and known payer behavior together, since the oldest claim isn't always the most at risk of becoming unrecoverable.
Ready to Stop Losing Claims That Just Went Quiet?
If your team can't say with confidence how many claims are sitting unworked right now, SPRY's team can walk through what real-time claim visibility would look like for your specific payer mix.
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Get a DemoLegal Disclosure:- Comparative information presented reflects our records as of Nov 2025. Product features, pricing, and availability for both our products and competitors' offerings may change over time. Statements about competitors are based on publicly available information, market research, and customer feedback; supporting documentation and sources are available upon request. Performance metrics and customer outcomes represent reported experiences that may vary based on facility configuration, existing workflows, staff adoption, and payer mix. We recommend conducting your own due diligence and verifying current features, pricing, and capabilities directly with each vendor when making software evaluation decisions. This content is for informational purposes only and does not constitute legal, financial, or business advice.
