Claims approaching
timely filing.
Nothing escalated. Revenue gone.
- Timely filing windows — typically 90 to 365 days depending on the payer — are absolute. A claim that misses its window is permanently unrecoverable. No appeal. No exception. The revenue is gone.
- Aged AR requires continuous monitoring across hundreds of open claims and dozens of payers simultaneously. At the point a processor notices a claim approaching its timely filing deadline, it is often too late to gather the documentation and complete the follow-up required.
- The work involved in AR follow-up — identifying the claim status, contacting the payer, gathering outstanding documentation, resubmitting — is defined and repeatable. It is administrative overhead absorbing clinical billing staff who could be working complex cases.
A claim submitted 80 days ago has not paid. It is sitting in a payer's processing queue — or it was denied and the denial was never worked. The billing team reviews their AR aging report on Fridays. They see the claim. The timely filing window closes in 10 days.
There is not enough time to gather the required documentation, submit the corrected claim, and receive payment before the window closes. The revenue is written off. The amount was $1,200. It happened 14 times this month.
The AI agent monitors every open claim against its timely filing window continuously — not weekly. When a claim reaches 60 days without resolution, the agent initiates follow-up automatically: checks payer portal status, identifies what is outstanding, and begins the collection or resubmission workflow.
When a claim reaches 75 days, the agent escalates to the billing team with the specific status, the days remaining, and a recommended action. The team acts on a diagnosed problem with time to resolve it — not a list of claims that have already aged out.
What AI agents resolve
before the window closes.
| Use Case | What the AI Agent Does | Outcome |
|---|---|---|
| Timely filing monitoring | Monitors every open claim against its payer-specific timely filing window. Initiates follow-up at defined thresholds — 60 days, 75 days — and escalates to the billing team at 80 days with the specific status and action required. | Revenue lost to missed timely filing windows eliminated for monitored claims. Billing team receives actionable escalations, not post-mortem reports. |
| Payer portal status checks | Checks claim status on payer portals for open AR on a defined cycle. When a claim shows as pending beyond the payer's stated turnaround time, initiates follow-up contact and logs the interaction. | Claims sitting unactioned in payer queues identified and escalated before they age out. Follow-up lag eliminated. |
| Outstanding documentation collection | When an aged claim is blocked by outstanding documentation, identifies the specific items required, issues structured requests to the correct clinical contacts, and tracks receipt against the timely filing deadline. | Documentation-blocked claims resolved before the timely filing window closes. Follow-up cycle runs automatically, not when someone remembers. |
| Denial identification in aged AR | Identifies claims in the aged AR queue that were denied but not worked. Routes them to the denial management workflow with the denial reason, the appeal window, and the days remaining. | Denied claims in aged AR identified and entered into the appeal workflow before the appeal window expires. Revenue written off as "no response" substantially reduced. |
| AR reporting and visibility | Maintains a real-time view of AR aging by payer, by age band, and by status. Surfaces claims approaching timely filing risk for billing leadership review — before they become write-offs. | Billing leadership has a current, accurate AR aging picture without relying on weekly manual reports. Systemic payer issues identified early. |
AR follow-up involves contact with payers, documentation requests, and claim resubmissions on behalf of the practice or health system. If a payer or auditor asks what follow-up was performed on a specific aged claim, that record must exist and be retrievable without reconstructing it from processor notes.
PLRX logs every agent action on every claim it touches. Every status check run, every portal query made, every follow-up contact initiated, every escalation issued — captured in a structured, timestamped record. The complete follow-up history for any claim is queryable by claim number, payer, and date range.
If a payer denies a claim on timely filing grounds and you need to demonstrate that follow-up was initiated within the window, the PLRX audit trail provides that evidence. The record is complete from the first status check through the final resolution — without depending on processor recall or email history.
Revenue that ages past the timely filing window is not a capacity problem. It is a monitoring gap that compounds every week.
PLRX AI agents monitor every open claim continuously — initiating follow-up at 60 days, escalating at 75 days, and surfacing time-critical claims to your billing team before the window closes. The write-offs stop being inevitable.