25–35 Days to Commercial Payment, 14 Days for Medicare — Track Every Deviation
The commercial payer payment timeline benchmark is 25–35 days from clean claim submission to electronic remittance. Medicare processes clean claims in 14 calendar days under the prompt payment statute. When a commercial payer's average payment time exceeds 40 days, you have a contract issue, a claim quality issue, or a payer processing issue — and you cannot address it until you can measure it.
Vizier tracks the complete claim lifecycle: date of service → charge entry → claim submission → clearinghouse acceptance → payer acknowledgment → payment or denial. Each stage has a latency benchmark. A claim that sits in "clearinghouse accepted" status for 5+ days without payer acknowledgment indicates a payer queue problem worth escalating.
Days in AR by payer, by service line, and by provider shows you where collections are slowing. The 35–45 day commercial benchmark and the 14-day Medicare benchmark are targets — when a payer's aging bucket exceeds these, the Vizier dashboard surfaces the variance and calculates the estimated cash flow impact.
Denial Patterns by Root Cause — Not Just Volume
The aggregate denial rate tells you there is a problem. Root cause analysis tells you where to fix it. Prior authorization failures (23% of denials) require a different intervention than eligibility errors (15%) or coding issues (9%). Vizier categorizes every denial and tracks trends by category, payer, and provider — separating preventable denials from clinical disputes.
A 1% Clean Claim Rate Improvement at $50M Revenue = $500K Additional Collections
The industry benchmark for clean claim rate is 95%+. A clean claim is a claim that is accepted by the payer on the first submission without any additional information, correction, or follow-up. At a 93% clean claim rate on $50M in annual submissions, $3.5M in claims require rework — and 65% of those will not be collected.
First-pass resolution rate (FPRR) measures the percentage of claims that are paid without any rework. The distinction between clean claim rate and FPRR matters: a claim can be "clean" but still require follow-up for low payment or EOB discrepancy. Vizier tracks both metrics by payer, provider, and service line.
Collection effectiveness index (CEI) — net collections divided by net collectible revenue — should benchmark above 95%. Below 90% indicates either high write-off rates, excessive bad debt, or collection process failures. Prior authorization analytics show PA volumes by payer and CPT code, identifying which services carry the highest PA burden and where PA team staffing should be concentrated.
Revenue Intelligence Across the Financial Team
FAQ
Revenue Cycle Director Questions on Denials and Payer Performance
How does Vizier categorize denials at the CARC/RARC code level?+
Vizier maps every denial to its Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC), then aggregates into actionable root causes. The most common CARC codes include CO-4 (procedure code inconsistent with modifier), CO-16 (claim/service lacks information), CO-18 (duplicate claim), CO-29 (timely filing), CO-97 (benefit included in another service's allowance), CO-109 (claim not covered by this payer), and CO-204 (service not covered under the patient's plan). Per-payer trending catches policy changes early.
How is clean claim rate calculated and what does Vizier benchmark against?+
A clean claim is one that pays on first submission without any denial, rejection, or request for additional information. Clean claim rate is (clean claims / total submitted claims) in a given period. Industry benchmark is 95%+; below 90% signals systemic upstream problems (eligibility, coding, documentation). Each 1-point improvement at $50M revenue equates to roughly $500K in additional collections through avoided rework and earlier cash flow.
How does Vizier track payer contract performance against negotiated rates?+
For each commercial payer contract, Vizier compares actual paid amount per CPT against the expected contracted rate. Underpayments are flagged with the dollar variance and the CPT volume affected. Payer scorecards show first-pass denial rate, average days to payment, and the dollar value of underpayments — the data set you bring to a contract renegotiation conversation.
Can Vizier identify E&M coding outliers among providers?+
Yes. Vizier computes each provider's E&M distribution (99213/99214/99215 for established patients, 99202–99205 for new patients) and compares to peer means within specialty. Providers more than 1.5 standard deviations from peer mean are flagged for both under-coding (revenue leakage) and over-coding (compliance risk). The output is the dataset typically used in internal compliance audits.
How does Vizier report AR aging?+
Vizier reports AR aging by 0–30, 31–60, 61–90, 91–120, and over 120 days, by payer and by service line. Total AR days, AR over 90 days as a percentage of total AR (benchmark <15–20%), and net collection rate are tracked daily. Each AR day above benchmark represents approximately $28,000 in working capital tied up per 100-physician group.
Does Vizier identify unbilled or missed-charge revenue?+
Yes. Vizier reconciles clinical encounters against billed claims and surfaces encounters without a corresponding claim, encounters with diagnosis/procedure documentation suggesting an additional billable code was missed, and split/shared visits where billing rules are not optimized. The output drives a workflow handoff to the coding team or front-office staff.
Find What's Being Left on the Table in Your Claims
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