Guides Fixing lost revenue
Old AR: which unpaid claims are still worth chasing
The short answer
An old claim is worth working if a filing, reconsideration or appeal deadline is still open and the expected recovery is more than the cost of working it. Sort by deadline first, then by dollars, and document everything else under a written write-off policy.
An old unpaid claim is worth chasing when two things are true: a deadline is still open (the filing limit if the payer never accepted the claim, or the reconsideration or appeal window if it was denied or underpaid), and the amount you can expect to recover is more than the cost of working it. Age alone doesn’t decide it. A 200-day-old denial with an open 12-month appeal window can be collected. A 95-day-old claim that never reached a 90-day payer usually can’t.
This guide sets out the triage rule, which claims are usually lost and which aren’t, how to set your own dollar floor, the New York rules on patient balances, and how billing companies price old AR work. It is general information. Deadlines change and contracts override manuals, so check each claim against the payer’s current rules and your agreement.
Step 1: Pull the right list
An AR aging report by bucket isn’t enough. You need one line per claim with:
- payer and plan type (fully insured, self-funded, Medicaid managed care, Medicare)
- date of service and original submission date
- status: never sent, rejected, accepted with no response, denied, paid low, or patient balance
- denial reason code (CARC) and date of the last remittance
- balance and last follow-up note
If your system can’t produce that list, start from the payer-level detail behind the aging report. Our AR aging guide explains the buckets.
Step 2: Find which clock applies to each claim
The status tells you which deadline governs. This is the key step in triage.
| Claim status | The deadline that matters | Where to find it |
|---|---|---|
| Never sent, or rejected and never accepted | Initial timely filing limit | Your agreement and the payer manual; see the New York timely filing table |
| Accepted, no payment or denial | None has run out yet, but follow up now | Claim status (276/277) or the payer portal |
| Denied | Reconsideration or appeal window, usually counted from the remittance date | Payer manual, the denial letter |
| Paid less than the contract | Payment reconsideration or dispute window | Payer manual, your fee schedule |
| Patient balance | No payer deadline, but state collection rules apply | See the patient AR section below |
A few windows, as published in November 2026:
| Payer | Window to dispute a processed claim | Source |
|---|---|---|
| Medicare | Redetermination within 120 days of receiving the initial determination; reopening for any reason within 1 year, or 4 years for good cause | 42 CFR 405.942, 405.980 |
| UnitedHealthcare commercial and Oxford | 12 months from the original EOB or PRA | UHC 2026 Administrative Guide |
| Anthem (NY commercial) | Reconsideration within 180 days of the EOP; appeal within 90 days of that decision | Anthem NY Provider Manual |
| Cigna Healthcare | 180 calendar days from the payment or denial notice | Cigna appeals |
| Healthfirst | Reconsideration within 90 days of the EOP paid date | Healthfirst NY Provider Manual |
| Fidelis Care (Medicaid, CHP) | Claims appeal within 60 days of the remittance advice | Fidelis Care Provider Manual |
| eMedNY fee-for-service | Adjustments within 60 days of notification; nothing payable after 2 years from service except for Department error or a court order | eMedNY General Billing |
Your participation agreement can set different windows. Where it does, the agreement governs.
Step 3: Sort into recoverable, maybe and dead
| Situation | Usually | Why, and the exceptions |
|---|---|---|
| Accepted by the payer, no response | Recoverable | Nothing has expired. On New York-regulated plans, clean electronic claims are due in 30 days, with interest after that under Ins. Law §3224-a(a) and (c). |
| Denied, appeal window still open | Recoverable | Fix the cause and appeal or correct within the window. |
| Paid below contract, window still open | Recoverable | Needs your fee schedule. Underpayment disputes can have a cost: see the set-off note below. |
| Never accepted, still inside the filing limit | Recoverable | Fix and send it this week. |
| Never accepted, past the filing limit, but you have proof it was accepted earlier | Maybe | A payer acceptance report showing the original date can reverse a late-filing denial. |
| Late on a New York fully insured plan, under 365 days from service | Maybe | §3224-a(h) lets a participating provider ask for reconsideration when the delay came from an unusual occurrence and you have a pattern of filing on time. Payment can be cut by up to 25%. |
| eMedNY claim with a valid delay reason | Maybe | Each delay reason code has its own window, usually 30 or 60 days from when you were notified. |
| Never accepted, past the filing limit, no proof, no exception | Dead | Participation agreements usually bar billing the patient for it too. Check yours. |
| Denied, appeal window closed | Mostly dead | Medicare’s reopening rules are one exception. Some commercial manuals allow late appeals only for extenuating circumstances. |
| eMedNY claim over 2 years old | Dead | Unless the delay was the Department’s error or a court ordered payment. |
Sources: NY Ins. Law §3224-a, eMedNY General Billing, and the payer manuals above.
The set-off note. On New York-regulated plans, Insurance Law §3224-b(b) generally bars a plan from starting overpayment recovery more than 24 months after it paid. But if you claim an underpayment, the plan can set off overpayments going back as far as the underpayment you’re claiming (NY Ins. Law §3224-b). Before you dispute a batch of old underpayments, check whether you were overpaid on any claims from the same period.
Step 4: Set your own dollar floor
There is no public benchmark for the dollar amount below which a claim isn’t worth working. It depends on your staff cost, the payer, and how often that kind of claim gets paid in your practice. Build the number from your own data:
- Cost to work one claim: the loaded hourly cost of whoever works it, times the typical time per claim, times the typical number of touches (calls, portal checks, appeal letters).
- Expected recovery: the open balance times the share of similar claims you actually collected in the past 12 months. Use the same payer and denial reason if you have enough history.
- Work the claim if expected recovery is clearly above the cost.
Example (illustrative numbers only): a biller’s loaded cost is $36 an hour, an appeal takes about 40 minutes over two touches, so working the claim costs about $24. A $180 denial of a type you’ve collected on half the time has an expected recovery of $90, so it’s worth working. A $40 balance with the same odds ($20 expected) isn’t, unless the same fix clears a batch of identical claims at once.
The batch point matters. One wrong modifier or a missing referral number can sit behind 60 small denials, and one fix can resubmit them all. Group by denial reason before applying the dollar floor.
Step 5: Work in deadline order
Within the recoverable and maybe groups:
- Closest deadline first. A claim with 10 days left goes before a bigger claim with 10 months left.
- Then largest expected recovery.
- Then batches that share a single fix.
Write the deadline on every claim note. “Called payer, pending” with no date is how claims slide past the window.
Patient AR: New York rules to know
Old patient balances have no payer deadline, but New York limits how practices collect them. Two statutes to read with your attorney:
- Three-year lawsuit limit. CPLR §213-d says an action on medical debt by a hospital or a licensed health care professional must be started within three years of treatment (NY CPLR §213-d).
- No credit reporting. Public Health Law §4926 says hospitals, licensed health care professionals and ambulance services may not furnish any part of a medical debt to a consumer reporting agency, and their contracts with collection agencies must prohibit it (NY PHL §4926).
Before sending old patient balances to a collection agency, check two things. Is the balance actually the patient’s? Some “patient” balances are denials that were moved to patient responsibility by mistake. And does the agency’s contract include the no-reporting clause? This guide doesn’t advise on whether or how to pursue a balance.
Write it off under a written policy
Some claims will be dead. Writing them off is an accounting decision with tax and audit consequences, so agree a written policy with your accountant rather than deciding claim by claim. Points that policy usually needs to settle:
- which categories are written off (for example, timely filing denials with no exception, balances under your floor after a set number of attempts)
- who approves write-offs, and above what amount a second approval is needed
- which adjustment codes your billing system uses, so a timely filing write-off isn’t mixed in with contractual adjustments
- what documentation stays with the claim
Track timely filing write-offs as their own category. They show where your process failed, not where payers failed.
How billing companies price old AR
Three common ways billing companies price old AR work:
- Contingency: the company keeps a share of what it actually recovers.
- Hourly or per claim: you pay for the work, whether or not money comes in.
- Included: old AR is folded into the ongoing fee, sometimes up to a cutoff date.
There is no public source for typical rates, so compare written quotes. Whatever the model, get these answers in writing:
- What counts as “recovered”? Payments only, or also adjustments and patient payments?
- Are old AR collections ever also charged at the ongoing rate?
- Which claims are excluded, such as claims past the filing limit or below a dollar floor?
- When does the project end, and what happens to claims still in appeal then?
Marlow works old AR on contingency, billed only on what’s recovered and never also at the core rate; details are on the pricing page. The free audit sorts your old claims into still-open and expired using your 835s and AR aging.
Sources
- NY Insurance Law §3224-a (prompt pay, 120-day filing, late-claim reconsideration)
- NY Insurance Law §3224-b (overpayment recovery limits and set-off)
- 42 CFR 405.942 (Medicare redetermination)
- 42 CFR 405.980 (Medicare reopenings)
- eMedNY: Information for All Providers, General Billing (version 2025-1)
- UnitedHealthcare 2026 Care Provider Administrative Guide
- Anthem Blue Cross and Blue Shield New York Provider Manual
- Cigna Healthcare: Appeals and disputes
- Healthfirst New York Provider Manual
- Fidelis Care Provider Manual (Medicaid, CHP)
- NY CPLR §213-d (medical debt, three years)
- NY Public Health Law §4926 (medical debt reporting)
General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version.