A/R & Denial Management

Organized follow-up for open receivables, denials, payer responses, and client-directed next actions.

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Service scope

What the workflow addresses

Open balances and denials can be difficult to prioritize when payer correspondence, documentation needs, and internal follow-up are spread across aging queues. A disciplined queue process helps distinguish routine follow-up from issues that require a decision or escalation.

Defined deliverables

A/R queue review and prioritization support
Denial categorization and research workflow
Payer follow-up documentation
Escalation and appeal-support coordination

Final deliverables, systems, volumes, and review points are confirmed during scope definition.

Scope in practice · interactive example

Turn an aging balance into an actionable follow-up.

Two unpaid claims have the same age but different causes: one is waiting for payer processing, while the other needs a documentation decision. They should not receive the same next action.

How the work moves

Illustrative · not live client data

Source inputAccount balance, age, and latest payer response

Assigned actionClassify the open balance

Usable outputA reason-based work category

What happens at this step

Identify whether the item is pending, rejected, denied, under review, or awaiting a client action.

Read every example stage

Classify the open balance
Input: Account balance, age, and latest payer response
Identify whether the item is pending, rejected, denied, under review, or awaiting a client action.
Output: A reason-based work category
Boundary: An unexplained balance is researched before it is treated as a denial.
Build the follow-up record
Input: Submission history and available supporting records
Document the inquiry, response, reference, required next step, and any source dependency.
Output: A usable account note and follow-up task
Boundary: An appeal or documentation submission waits for the required client authorization and records.
Return the decision
Input: Unresolved payer position or financial question
Present the issue, work already completed, available next routes, and the decision owner.
Output: An escalation ready for client review
Boundary: Settlement, write-off, refund, and appeal strategy are not assumed by the operational team.

Clear ownership

Responsibility boundaries

The engagement begins with a documented division of work. ShanMedTech supports the assigned operational process; the client and provider keep their decision authority.

SMT

ShanMedTech

Manage the agreed work queues and maintain documented account activity.
Identify recurring denial themes for operational review without representing guaranteed results.

Client / provider

Provide requested records, approvals, and policy direction for escalated accounts.
Retain final decisions on appeals, adjustments, and patient financial policy.

Operational visibility

Reporting and system touchpoints

Work can be organized within client-approved systems and access boundaries defined for the engagement. The reporting format and cadence are selected around the assigned workflow; no live integration is implied.

Illustrative operations viewScope-defined

Age with a reason

View aging together with payer status and the actual blocker rather than using age alone.

Last meaningful action

Distinguish a substantive payer response from a repeated status check with no new information.

Decision-ready escalations

Identify the records, approval, or direction still required from the client.

Qualified value

Operational benefit

Reason-based queues help teams distinguish payer waiting time, missing documentation, disputed balances, and decisions that require client approval.

Actual results depend on client inputs, documentation, payer decisions, systems, and the agreed scope. ShanMedTech does not promise a particular financial, clinical, credentialing, or payer outcome.

Public-site boundary

Data-practice boundary

Consultation forms are for business inquiries only. Use Careers for job applications. Do not include patient or protected health information. Operational safeguards, access boundaries, and contracting requirements are assessed for each engagement before operational work begins.

Questions about the scope

Frequently asked questions

These answers describe the operating boundary. Final responsibilities are documented for each engagement.

Yes. A defined backlog or payer category can be scoped as an operational workstream.

Start with the workflow you need to strengthen.

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