The aging report is open, with the familiar AR aging buckets (unpaid balances grouped by how old they are): under thirty days, thirty to sixty, sixty to ninety, older.
The total in the sixty-day aging column is the number everyone watches this morning.
It tells you how much is unpaid, but it doesn’t tell you where those claims stopped, or why.
Here’s the answer: a sixty-day bucket can be one quiet insurer, a stack of claims built and never sent, or payments that landed and never got recorded.
Same age, three different stuck points, three different fixes.
Until you see the path, you’re guessing which one you have.
Same bucket. Three different breaks.
Aging groups money by how long it has waited, and it hides the last stop each claim reached.
Picture the money path in plain words.
A visit becomes a charge (the visit written as a billable line), and the charge becomes a claim, the bill to the insurance company (the payer).
The claim moves through a clearinghouse (the middleman that carries claims between you and payers), then the payer answers with pay or deny.
Someone records that answer, and money hits the bank.
The claims path is the middle of that journey, from “claim exists” to “answer is recorded.” Owning that view is the job of whoever watches the whole money path.
Related maps: denials start here, appointments you will never be paid for, and the front door.
The five stops on the claims path
Put every open claim at its last real stop:
- Built: charge exists as a claim in your system, not yet sent.
- Sent: left your system for the clearinghouse or payer.
- Accepted: clearinghouse or payer took it in (not rejected for format or enrollment).
- Answered: payer paid, denied, or partially paid.
- Recorded: answer posted in billing so the balance matches reality.
Wherever most claims are stuck is where money stopped moving.
That pile isn’t always where the aging report points, because a claim can look young by age and old by path.
Start at the biggest backlog on the path, not the biggest aging bucket.
What a backlog at each stop usually means
Stuck at built: work never left the building, so the first move is submit, not appeal.
Stuck at sent: claims left you and went quiet, so the first move is acceptance or enrollment follow-up, not a full coding scrub.
Stuck at accepted, unanswered: the payer has it and hasn’t answered, so the first move is status chase on that payer, not a new round of charge entry.
Stuck at answered, not recorded: remits (payment advices from the insurer, also called ERAs or EOBs) exist, but posting (recording in the billing system) didn’t finish. Cash may already be at the bank, but aging still shows the balance.
Match the fix to the stop, because a mismatch wastes a week.
The days between the stops are where money ages
A map carries time, not just place: the gap between two stops is how long a claim waited there.
A claim can clear the first stops fast and then sit for weeks at the insurance company. Another can look recent on the aging report while it has been stuck at built, never sent, since the visit, aging quietly in your own system.
Put the days on the map and the slow stretches show themselves: the age of the money matters less than how long it has stood still at one stop.
A young claim frozen at built is older, in cash terms, than an older claim that’s still moving through answers.
The dollars on each stop show where to spend an hour
Place the money on the map too, not just the count.
A stop crowded with claims but holding little money is a nuisance, while a stop with fewer claims but most of the dollars is where an hour of work pays.
The map lets you sort the stalls by money, so the biggest dollar stack gets worked first.
An aging report can rank buckets by dollars, and it still can’t say which stop inside the bucket to attack. The map can, because it grouped the money by stop before it ranked it.
Work dollars first, then days stood still, then claim count, because that order keeps the first hour on cash, not on busywork.
What the map shows that a pile cannot
The aging report says you have a lot of money at sixty days. The map says most of that money is sitting at one stop, accepted by the insurance company and never answered, for three insurers, and here are their claim numbers.
One sentence a person can act on today.
This is a view you build and read from data you already have. It doesn’t require anything to run on its own, and reading it once a week is enough to catch a stall while it’s still small.
Real situations that look the same on aging
A practice with a large sixty-day bucket finds most of it is claims built last month and never submitted, so the fix is send, not chase.
Another practice’s sixty-day aging column is almost all one insurer that stopped answering, so the fix is enrollment or follow-up with that payer, not a scrub of every claim.
A third practice has payments already returned on remits that nobody posted, so aging still shows the balance. The money may already be deposited at the bank, but the record isn’t.
Why the usual metric stays green
Days in A/R (accounts receivable, money billed but not yet paid) and aging totals can look “normal” while more claims sit stuck at built.
Age averages hide which stop is broken, and an aging report that looks fine with a stuck path is how cash thins while everyone defends the report.
The path map doesn’t replace aging, but it tells you which aging dollars to work first, and with which move.
What to do this week (simple check)
- Pull open claims, not just aging totals.
- Tag each one with its last real stop: built, sent, accepted, answered, recorded.
- Count the pile at each stop, and put dollars on each pile.
- Work the biggest dollar backlog first with the fix that matches that stop (send what never went out, chase what went quiet, post what already paid).
- Recheck the map next week. The biggest backlog should move.
Why this matters for cash
Every day a claim sits at the wrong stop is a day payroll and rent wait on money that already should be moving.
Revenue can look fine while cash thins out, because revenue counts the bill and cash counts the bank.
Fix the stop, and the bucket ages down on its own, but fix only the bucket, and the same stop fills again next month.
What this means for you
Open last week’s aging report and pick the biggest bucket.
Before you work it line by line, ask which stop those claims actually reached, then count the piles, put dollars on each, and put one owner on the biggest money stop.
That’s the map, and that’s where medical claims get stuck.
Grab 30 minutes with us. Prep nothing. You will see where next week’s open claims are actually stuck, and which stop to clear first.
Questions people ask
Where do medical claims get stuck?
Medical claims get stuck at four points: built but never sent, sent but never accepted, accepted but never answered, and answered but never recorded in billing. A claim is the bill to the insurance company, and it sits at its last real stop until someone moves it. Age alone can’t name that stop, so tag each open claim with where it actually stopped.
Why isn’t the aging report enough to find stuck claims?
An aging report (unpaid balances grouped by age) sorts by time and hides where each claim stopped. A sixty-day bucket can be one quiet insurer, claims built and never sent, or payments that landed and never got recorded. Those need three different fixes, so you need the last stop each claim reached.
What’s a claims path map?
It’s a picture of a claim’s journey, with every open claim placed at the last stop it reached: built, sent, accepted, answered, or recorded. A claim is the bill to the insurance company. The map groups unpaid money by where it stopped moving, so a stall becomes a specific problem you can find and work.
Do I need new software to see where my claims are stuck?
No. The stops a claim passes and the answers that come back are already in your billing system and your clearinghouse (the middleman that carries claims to insurers). Start with a count of open claims by last stop, with dollars on each pile. Reading it once a week is enough to catch a stall while it’s still small.
Where should I start if all my claims look behind?
Put dollars on the map and work the stop holding the most money, not the most claims. A stop crowded with small balances is a nuisance, while a few large claims parked at one stop is where an hour of work pays. After dollars, rank by how long claims have stood still, then by count.
Can a claim look current on aging and still be stuck?
Yes. A claim can look recent on the aging report (unpaid balances sorted by age) while it has sat at built, never sent, since the visit. Age counts calendar days, and the path shows whether the claim moved. In cash terms, a young claim frozen at built is older than an older claim still moving through answers.