Quick Answer: In an 18-month claims investigation at a nationwide medical practice, more than 30 insurance carriers had been billed for months and had never sent back a payment, a denial, or a remittance. Nearly all were Medicaid plans in states the practice had recently entered. The cause was enrollment: payer and EDI setup never completed, so claims never entered the carriers’ adjudication systems, and no rejection came back to say so. A carrier that has never responded needs an enrollment check today, because filing deadlines of 90 to 180 days keep running.
Somewhere on your aging report is a carrier balance that has stopped registering as strange. You billed them. Months passed. Nothing came back, so someone marked the claims “in process” and moved on. Every week the balance grows a little, and every week it looks a little more normal.
We hit this pattern in a claims investigation for a nationwide practice running on AdvancedMD, written up in full in Your Claims Went Somewhere. Nobody Could Say Where.. Out of roughly 180 carriers, more than 30 had never responded at all. Not one payment, denial, or remittance had ever come back from any of them. Silence, at scale.
Silence is strange behavior for a carrier. A carrier that receives a claim does something with it: pays it, denies it, or asks for more information. Even a lowball payment produces a remittance explaining itself. Total silence points somewhere else entirely. The claim never made it into the carrier’s adjudication system in the first place.
Which is what the data showed. Nearly every silent carrier was a Medicaid plan in a state the practice had recently expanded into. The practice had grown fast; the enrollment paperwork had not kept up. At the worst of them there was no EDI enrollment at all, the electronic connection a carrier requires before it will accept a claim. Claims were going out on schedule and getting blocked at the door. And because nothing entered the system, nothing came back, and no report flagged it.
That last part is worth sitting with. A denial gets worked and a rejection gets fixed. Silence just gets older. The aging report showed these balances as “old AR,” the same label it gives a slow payer, and old AR is a category billing teams learn to live with.
Why silence is the most expensive category on the report
Insurance contracts set filing deadlines, commonly 90 to 180 days from the date of service. A claim that misses the window becomes legally unpayable, and the write-off that follows never has to be explained to anyone. At the silent carriers, every claim was aging toward that cliff with nobody assigned to it, because nobody knew the category existed. A slow payer costs you interest. A silent payer costs you the principal.
Nobody involved did anything wrong. The billing team was submitting on schedule. The carrier never saw the claims. The gap was setup work, payer enrollment and EDI paperwork, which has no queue and no owner in a growing practice because everyone assumes it was finished at go-live.
The same investigation surfaced a cousin problem worth separating: carriers that paid normally and then went quiet. More than a dozen of those, one silent for eight months while claims kept going out. Those are different. They engaged once, so the enrollment existed and something later cut the path, a credentialing lapse or a bank-account change nobody escalated. The fix there starts with a phone call that opens with a date: you stopped paying us on December 4th. The never-answered carriers get a different first move, because there is nobody useful to call until the enrollment exists.
How to find yours in ten minutes
You do not need new software to check this. Run your AR grouped by carrier and look for one signature: billed dollars above zero, paid dollars at zero, and zero remittances on file, sustained over months. A carrier matching all three has never engaged with you. That signature is different from slow, and it is different from denied. It means unreachable.
For each carrier that matches, check two things: whether your payer enrollment for that carrier and that state is complete and confirmed, and whether an EDI connection exists at your clearinghouse. In our investigation, that one query surfaced every silent carrier on the book, and the verdict for each read in plain English: this carrier has never responded to us. Confirm we are enrolled before the filing deadline.
The practice that finds this in month two keeps the money. The practice that finds it in month fourteen documents a loss. The data is identical in both cases. The difference is whether anyone gave “never responded” its own column.
Grab 30 minutes with us. You’ll leave with the list of carriers that have never answered you.
Questions people ask
Why would an insurance company never respond to claims?
Because the claims never reached its adjudication system. Missing payer enrollment or a missing EDI connection blocks a claim at the door, and no rejection reaches the billing queue to say so. The carrier is not ignoring you. It has no record you billed it.
What is EDI enrollment?
EDI (electronic data interchange) enrollment is the setup that lets a carrier accept your claims electronically. It is completed carrier by carrier, usually through your clearinghouse. Without it, submitted claims have nowhere to land, and the carrier has no record of the bill or any obligation to respond.
How do I find carriers that have never paid us?
Group your AR by carrier and filter for billed above zero, paid at zero, and zero electronic remittances, sustained over months. That signature separates a slow payer from a carrier that has never engaged. In one 18-month investigation it surfaced more than 30 silent carriers out of roughly 180.
Do filing deadlines still apply if the payer never responded?
Yes. Filing windows, commonly 90 to 180 days from the date of service, run whether or not the carrier ever received the claim. Silence does not pause the clock. Confirming enrollment before the oldest claims cross their deadlines is the urgent step, ahead of any rebilling.
PracticePath is not affiliated with, endorsed by, or sponsored by AdvancedMD. AdvancedMD is a trademark of AdvancedMD, Inc. All references are for descriptive purposes only.