Executive summary. An adjudicated claim becomes an actionable exception once it passes a documented payment-cycle expectation for its payer and payment method.
Definition
Missing-remittance aging is the practice of identifying adjudicated claims that have not received a corresponding remittance within an expected time window.
Start the correct clock
Use the adjudication or accepted-claim date that fits the payer workflow, rather than the original encounter date. A queue built on the wrong event produces noise, and staff learn to ignore noisy queues.
Set thresholds per payer and payment method where the evidence supports different cycles, and revisit them on a schedule. One threshold applied everywhere chases claims that were always going to arrive late and misses the ones that never will.
Create a defensible chase path
A chase item should name the claim, the amount, the last known state, the payer contact path, and the next action date. Keep patient detail out of a general work queue unless the task genuinely requires it.
Close only on a linked remittance, a documented payer outcome, an adjustment, or an approved write-off rationale. Silence resolves nothing.
Frequently asked questions
Should every old claim be pursued?
Decide with contractual filing limits, cost to collect, materiality, and a named write-off authority. Record the decision so a reviewer can test it later.
Referenced standards and further reading
- CMS: Electronic funds transfer ↗Centers for Medicare & Medicaid Services
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