25 Jun How to Manage Claims for Particularly Slow Payors

We all have “that payor” that tends to reimburse more slowly than others.  In some cases these delays can be extreme, with months going by before payment is received.  In Illinois, the state’s group health program payments have been delayed for months, which will continue until Illinois passes a budget.  There are a variety of reasons why a particular payor may be slower to pay: lack of a budget providing funding for payments, decrease in resources due to financial struggles resulting in longer adjudication time-frames, etc.how to manage claims

How to Manage Claims for These Payors:

It is important to recognize these slower payors and take them in to account when working and analyzing your revenue cycle.  The increased length of time between claim submission and payment will affect not only your days in accounts receivable for that payor, but your overall days in A/R.  Depending on the volume this payor carries in relation to your overall payor mix, this may or may not have a significant impact.  Make note of this increased reimbursement interval when reviewing financial reports, or consider separating out the problem payor so that you can easily calculate what your financial performance would look like if you could exclude this payor.  If the problem is temporary, this method prevents a poor performer from skewing your overall financial picture.  If the problem persists, you may want to consider the costs and benefits of your contract with that payor.

Another consideration is parceling out the affected records from the rest of the records your billers are working.  You do not want them to waste time reviewing a claim that has received no response from the insurance company within 45 days if you know it is taking 90 days for this particular payor to pay.  Work with your software vendor to reset parameters for that payor to conserve the time of your billing staff.


Kathleen Heaton has worked in health care and business operations for over thirteen years, rising through the ranks to perform specialized roles in several capacities.  Kathleen came to PediaTrust, LLC and speroMD from Ann & Robert H. Lurie Children’s Hospital of Chicago, where she was Operations Manager for the independent Children’s Community Physicians Association.  Kathleen is an industry expert in credentialing and managed care contracting, and her primary focus is to oversee revenue cycle management for speroMD’s partners and affiliates.  She is the co-chair of the Practice Management Workgroup with Lurie Children’s Epic Community Connect program.  Kathleen is currently enrolled at Loyola University in Chicago for her Master of Jurisprudence in Health Law.  
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