Accounts receivable services aren’t a back-office cleanup task. They’re the difference between revenue earned and revenue collected. ClaimMax RCM provides accounts receivable services engineered to reduce days in AR, recover aged claims, and maximize the revenue your healthcare practice has already earned. From Sacramento, California, we work with practices in all 50 states.
Outsource accounts receivable to a partner that runs dual-track recovery: dedicated insurance AR specialists working payer relationships and dedicated patient AR specialists handling self-pay collections. Different work, different teams, same operational standard. ClaimMax AR services deliver under 28 days in AR and 90% recovery on aged claims. Payer-specific, aging-stage specific, built on accountable AR specialist teams.
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Aged AR is recoverable. Most practices write off claims that ClaimMax recovers because the work matches the aging stage. Different aging requires different operational tactics. ClaimMax operates five distinct AR teams running five distinct recovery protocols across the aging cycle. Each bucket has its own payer escalation matrix, its own root-cause framework, and its own recovery benchmark per HFMA reporting standards.
Claims aged 0 to 30 days. The active monitoring stage. AR specialists pull payer status updates daily through clearinghouse reports and payer portals. Eligibility rechecks, pre-emptive denial pattern detection, status verification across every payer. When claims slow at this stage, the AR team intervenes within 48 hours. The 98% First-Pass Acceptance Standard minimizes claim volume reaching subsequent buckets across every cycle.
Claims aged 31 to 60 days. The investigation stage. AR specialists identify root causes: payer information requests, missing documentation, eligibility lapses, prior authorization issues. Each delay categorized using CARC and RARC codes. Resubmissions filed with corrected information. Initial appeals filed for denied claims with documented payer policy violations. Weekly cadence touches, payer-specific escalation contacts, denial trend reporting back to practice leadership continuously.
Claims aged 61 to 90 days. The aggressive pursuit stage. Multi-channel recovery: payer portal disputes, phone follow-up calls, formal appeals, peer-to-peer reviews for clinical denials. Specialists work each claim using payer-specific protocols across managed care, commercial insurance, Medicare, and Medicaid workflows. Underpayment recovery starts here through contracted-rate reconciliation. Recovery rate at this stage averages 65 to 80 percent per HFMA benchmarks.
Claims aged 91 to 120 days. The specialist team stage. Dedicated aged AR specialists assigned per claim. Each claim gets root-cause analysis, payer relationship history review, and recovery feasibility scoring. Some claims pursued through formal appeals with clinical citations, others through patient billing transitions when insurance coverage has lapsed. Underpayment recovery deepens with contractual-rate audits, ERA and EOB line-level disputes, and payer escalation matrices.
Claims aged 120+ days. The most intensive stage. Senior AR specialists handle direct negotiation with payer recovery departments. Compromise settlements pursued where appropriate. Patient AR transitions for self-pay accounts. Small balance AR strategies coordinate with large dollar pursuit. Aged AR cleanup metrics tracked weekly. Practices working with ClaimMax recover an average of 30 to 45 percent of aged AR previously written off as uncollectible.
Insurance AR involves payer relationships, claim corrections, appeals, and underpayment recovery. Patient AR involves patient communication, statement workflows, payment plans, and self-pay collections. Different work, different teams, same recovery standard. High-deductible health plans now drive patient AR growth across the healthcare industry, and ClaimMax separates the two tracks deliberately because each requires distinct stakeholder protocols, compliance frameworks, and recovery tactics.
Payer-specific status verification, denial appeals workflows, and underpayment identification through contracted-rate audits. Multi-payer coordination across Medicare, Medicaid, TRICARE, BCBS, UnitedHealthcare, Aetna, Cigna, Humana, Kaiser Permanente, workers compensation, auto accident, and no-fault carriers. Dedicated payer follow-up teams, contractual-rate libraries, ANSI X12 835 ERA reconciliation, and peer-to-peer review coordination for clinical denials drive recovery on insurance accounts.
Patient statement workflows, high-deductible health plan balance management, payment plan setup, and HIPAA-compliant patient communication. Self-pay collections coordinated with the practice’s brand voice. Compliance with patient billing regulations including the No Surprises Act and state-specific patient billing laws. Branded patient statements, HIPAA-compliant text and email outreach, payment portal integration, and a dedicated patient AR caller team handle every patient account responsibly.
Switching AR vendors shouldn’t mean switching software. ClaimMax RCM works inside the practice’s existing EHR. No migration. No parallel database. No staff retraining. Aging data pulls directly from the system the practice already uses, claim status updates post back through bidirectional integration, and reconciliations happen within the existing workflow. AR follow-up services that integrate, not interrupt.
Healthcare practices have many accounts receivable services options. ClaimMax RCM differentiates on five operational specifics, delivered every cycle, every account, every report. Not aspirational claims. Operational realities engineered into how ClaimMax runs AR services for healthcare practices across all 50 states.
Every practice gets a dedicated AR specialist team assigned at onboarding. Named contacts, weekly cadence, named recovery specialists per aging stage. Insurance AR specialists separate from patient AR specialists. Accountable single-point ownership.
Recovery work is payer-specific, not generic. ClaimMax operates payer-rule libraries for Medicare, Medicaid, TRICARE, BCBS, UnitedHealthcare, Aetna, Cigna, Humana, Kaiser Permanente, and managed care plans with documented escalation matrices.
Live dashboards, not delayed monthly reports. Total AR, aging buckets, recovery rate by payer, and KPI trends updated continuously. Monthly performance reviews benchmark against HFMA and MGMA industry standards quarterly.
Live dashboards, not delayed monthly reports. Total denials, denial rate by category, recovery rate by payer, and KPI trends updated continuously. Monthly performance reviews benchmark against HFMA and MGMA industry standards.
Headquartered in Sacramento, California. Serving healthcare practices in all 50 states. US-based AR operations, US-based account management. HIPAA-compliant infrastructure with signed BAAs, 256-bit AES encryption, and SOC 2 compliant systems.
Healthcare practices that benefit most from ClaimMax accounts receivable services share common operational signals. Check the boxes that match your practice and submit the form for your free AR Aging Audit.
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Accounts receivable work involves continuous PHI access. AR specialists handle claim status, payer correspondence, and patient billing records daily. ClaimMax RCM’s compliance infrastructure is designed around this reality: signed BAAs before AR work begins, encryption at every layer, audit trails on every PHI touchpoint.
Every healthcare practice signs a Business Associate Agreement before AR work begins. ClaimMax operates under HIPAA Privacy Rule, HIPAA Security Rule, and HITECH Act requirements. PHI and ePHI protocols govern all data handling. OIG Exclusion List screening quarterly.
ClaimMax runs SOC 2 compliant infrastructure with 256-bit AES encryption for AR data at rest and in transit. Role-based access controls restrict PHI to assigned practices. Audit trails on every PHI touchpoint. Annual third-party SOC 2 attestation maintained.
Tell us where your accounts receivable stands. ClaimMax RCM provides a free AR Aging Audit that analyzes your aging report bucket by bucket, identifies recovery potential, surfaces underpayment opportunities, and quantifies revenue leakage. The audit is yours to keep, share with your team, or use however helps your practice grow. No commitment.
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