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A/R Follow-Up Agents: Working Every Dollar

Duration: 50 min · Level: Advanced · Module: 4. Claims Submission & Denial Management AI · Focus: A/R, claim-status, 276/277, follow-up, aging

Learning objectives

By the end of this lesson you will be able to explain and apply:

  • A/R aging buckets
  • Claim status check
  • 277 status codes
  • Payer-specific rules
  • Patient balance follow-up

Why this matters​

Accounts Receivable (A/R) management is the sustained pursuit of unpaid claims.

Overview​

Accounts Receivable (A/R) management is the sustained pursuit of unpaid claims. An A/R agent works every aging claim systematically — checking claim status, reworking pended claims, escalating to supervisors — without the fatigue and inconsistency of human follow-up teams.

Key concepts​

Key idea

A/R aging buckets: 0-30 days (active adjudication), 31-60 days (follow-up begins), 61-90 days (escalated follow-up), 91-120 days (demand letter/appeal), 120+ days (write-off or external collections consideration)

  • Claim status check: HIPAA 276/277 transaction for electronic claim status; Availity and payer portals for manual status; agent checks status of all claims >21 days old daily and triggers workflow based on status code
  • 277 status codes: A3 (claim received, pending), A6 (payer considers claim complete, payment forthcoming), A7 (payer received incorrect information), F2 (more information needed); each status code triggers a specific agent action
  • Payer-specific rules: some payers systematically pend certain claim types for manual review (high-dollar, certain diagnosis codes, flagged providers); A/R agent learns these patterns from historical data and builds payer-specific work queues
  • Patient balance follow-up: after insurance adjudicates, patient balance must be billed; AI agent generates personalized patient statement, sends via preferred channel (mail, email, text), monitors for payment, offers payment plan if balance exceeds threshold
  • Write-off decision support: claims beyond timely filing limits or in states with balance billing restrictions cannot be pursued; AI flags these for write-off approval rather than burning follow-up resources on uncollectable accounts

Check your understanding​

Try to recall each answer before expanding it.

Q1. What do you know about A/R aging buckets?

0-30 days (active adjudication), 31-60 days (follow-up begins), 61-90 days (escalated follow-up), 91-120 days (demand letter/appeal), 120+ days (write-off or external collections consideration)

Q2. What do you know about Claim status check?

HIPAA 276/277 transaction for electronic claim status; Availity and payer portals for manual status; agent checks status of all claims >21 days old daily and triggers workflow based on status code

Q3. What do you know about 277 status codes?

A3 (claim received, pending), A6 (payer considers claim complete, payment forthcoming), A7 (payer received incorrect information), F2 (more information needed); each status code triggers a specific agent action

Q4. What do you know about Payer-specific rules?

some payers systematically pend certain claim types for manual review (high-dollar, certain diagnosis codes, flagged providers); A/R agent learns these patterns from historical data and builds payer-specific work queues

Q5. What do you know about Patient balance follow-up?

after insurance adjudicates, patient balance must be billed; AI agent generates personalized patient statement, sends via preferred channel (mail, email, text), monitors for payment, offers payment plan if balance exceeds threshold

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Part of Module 4: Claims Submission & Denial Management AI.