Services · AR Audit and RCM Insights New

Know where your AR is leaking.
In under three days.

Adentris turns raw claims, denials, EOBs, payer responses, and chart evidence into a clear map of what is blocking cash. Aged AR, denial root causes, payer behavior, underpayments, eligibility breakdowns, authorization gaps, and clinical documentation risk. Run it once as a rapid AR audit, or continuously as a live revenue integrity command center.

Run a 3-day AR audit

No rip-and-replace. No long integration project. Start with the exports your billing, clearinghouse, and EHR systems already produce.

< 3 days
to first findings
Claim-level
denial, payer, AR analytics
RCM + clinical
documentation in one view
Ad hoc
or continuous monitoring
The problem

Your AR report tells you what happened.
It does not tell you why.

Most providers can see total AR, aging buckets, and denial counts. That is not enough. A $4 million AR balance can hide five different problems: claims sitting with no payer response, denials that were never appealed, underpayments accepted as normal, retro-terminated coverage, and clinical documentation gaps that make medical necessity hard to defend.

AR Audit and Insights connects the financial record to the operational workflow and, when chart data is available, to the clinical documentation behind the claim. The result is not another spreadsheet. It is a prioritized answer to one question: what should we fix first to protect revenue?

  • 01
    Aging buckets show time, not root cause.
  • 02
    Denial counts show volume, not recoverability.
  • 03
    Payment totals show outcomes, not payer behavior.
  • 04
    Documentation audits show gaps, often after the claim has already failed.
  • 05
    RCM vendors produce status labels; leadership needs an action plan.
Two modes

A fast audit when you need a snapshot.
Continuous insights when you need control.

Same analysis model, two operating modes. The ad hoc audit gives leadership a fast snapshot. Continuous AR Insights turns that snapshot into an operating rhythm.

Ad hoc

3-day AR Audit

A one-time snapshot of current revenue cycle performance. For leadership reviews, vendor oversight, margin pressure, payer disputes, acquisitions, board updates, and new market or service-line assessments.

What you get
  • Executive summary and payer scorecard
  • AR aging analysis with stuck-claim breakdown
  • Denial root-cause matrix with recoverability rating
  • Documentation quality findings (with chart data)
  • Recoverable revenue estimate
  • Prioritized claim-level action queue
First findings < 3 days from receipt of core data
Continuous

AR Insights

A recurring analysis layer across claims, denials, payer behavior, and documentation quality. For organizations that want ongoing AR visibility, early warning alerts, and a durable operating cadence across finance, RCM, clinical, and compliance teams.

What you get
  • Live or recurring dashboards
  • Payer trend alerts and denial spike detection
  • SLA breach monitoring
  • Documentation quality trendlines
  • Recovery work queues with owners
  • Executive-ready monthly insights
Cadence Weekly, biweekly, or monthly
Analysis coverage

Every claim tells a story.
We connect the financial, operational, and clinical chapters.

Adentris analyzes the revenue cycle from multiple angles at once. The goal is to show not just where dollars are stuck, but why they are stuck and what action is most likely to move them.

Aged AR and payer response

Open AR segmented by payer, date of service, status, aging bucket, and follow-up posture. Distinguishes new claims, claims aging without action, claims approaching timely filing risk, and claims stuck because payer behavior changed.

Denial root cause and recoverability

CARC/RARC codes, EOB/ERA detail, free-text notes, and payer responses grouped by root cause. Each denial tagged by recoverability, appeal pathway, payer pattern, owner, and the evidence needed to overturn it.

RCM operations quality

Billing workflow gaps that create preventable revenue loss: missing follow-up cadence, clearinghouse rejections, timely filing exposure, delayed payment posting, low-pay claims, unworked denials, and payer-specific bottlenecks.

Clinical documentation quality

Medical necessity support, level-of-care defensibility, diagnosis and treatment-plan alignment, missing signatures, note timing, authorization support, concurrent review gaps, and documentation patterns that create denial or audit risk.

Payer performance and contract footing

Billed, allowed, paid, adjusted, and balance amounts by payer, service line, and time period. Surfaces low-pay patterns, underpayments, concentration risk, and evidence for contract or single-case agreement discussions.

Eligibility, VOB, and authorization risk

Retro-terminated coverage, eligibility mismatches, authorization gaps, peer-to-peer timing issues, concurrent review failures, unfunded days, and cases where a stronger pre-service workflow could have prevented the denial.

Underpayments, adjustments, write-offs

Actual reimbursement compared to expected reimbursement when data is available. Variances flagged for review; silent write-offs separated from legitimate contractual adjustments so teams see what was abandoned too early.

Compliance and audit readiness

Patterns that can trigger payer audits, SIU scrutiny, recoupments, or regulatory exposure. The report connects risk back to chart evidence, claim history, payer correspondence, and the operational controls needed to defend the provider.

Continuous AR Insights

The same fact base. For every leader.

Synthetic preview of the continuous monitoring dashboard. Real engagements carry your data, your payers, and your service lines. Visuals shown are representative.

Run a 3-day AR audit
Deliverables

An executive-ready report. Plus the claim-level queue to act on it.

Within under three days of receiving the core data set, you get a decision-ready view of AR performance. The report is designed for leadership, detailed enough for RCM teams to work from immediately.

01

Executive snapshot

Total AR exposure, collection performance, payer concentration, denial burden, documentation risk, compliance risk, and the most important financial opportunities. One page, board-ready.

02

Payer scorecard

Payer-by-payer comparison of billed, paid, balance, collection rate, response timing, denial rate, low-pay patterns, and concentration risk.

03

Aged AR and status breakdown

Open balances grouped by age, claim status, payer, service line, and actionability. Separates normal payment lag from stuck claims and urgent follow-up opportunities.

04

Denial root-cause matrix

Denials grouped by payer, reason, recoverability, operational owner, clinical documentation driver, and recommended appeal or resubmission path.

05

Documentation quality findings

Chart-level and pattern-level findings explaining which clinical documentation gaps are increasing denial, audit, or recoupment risk.

06

Recoverable revenue estimate

Conservative, realistic, and aggressive recovery range based on payer behavior, claim age, denial reason, documentation support, and expected reimbursement.

07

Claim-level action queue

A prioritized list of claims to work first, including owner, next action, required evidence, payer deadline, expected value, and confidence level.

08

Compliance and audit risk register

Payer audit signals, SIU exposure, documentation defensibility issues, and recordkeeping gaps that require leadership attention.

09

Operating recommendations

Practical fixes for RCM operations, documentation workflows, authorization processes, payer follow-up cadence, denial routing, and underpayment review.

Under three days does not mean shallow. It means the first version is focused, automated, and built from the data that already exists.

Process

From data exports to executive answers in under three days.

01

Scope the question

Provider type, payer mix, service lines, time period, available data, leadership question. Common scopes: 60–90 days of denials, 12 months of AR, a single payer, a single facility, a new acquisition, or a full revenue integrity snapshot.

02

Send the core data

Start with exports you already have: claim detail, AR aging, payment posting, denial status, EOB/ERA/835 files, payer list, service-line detail. For documentation analysis, add chart samples or EHR access.

03

Adentris normalizes the data

Clean payer names, group claim statuses, match payments to claims, parse denial reasons, identify aging buckets, calculate payer performance. Prepare the analysis model.

04

AI and expert review

The platform detects patterns across AR, denials, payer behavior, underpayments, authorization, and documentation quality. Analysts validate edge cases and convert findings into an action-ready report.

05

Receive the report and work queue

Executive summary, payer scorecard, denial matrix, recoverable revenue estimate, documentation findings, compliance risk register, and a prioritized claim-level queue.

06

Decide the operating model

Use the ad hoc report for immediate recovery, vendor oversight, payer escalation, or leadership planning. Or convert to Continuous AR Insights with recurring dashboards, alerts, and trend monitoring.

Core data in. First findings out in under three days.

Value by role

One analysis. Different answers for every healthcare leader.

Revenue leakage can originate in payer strategy, billing operations, clinical documentation, utilization review, compliance controls, or executive oversight. AR Audit and Insights translates the same claim-level analysis into the questions each leader needs answered.

CEO

See whether revenue leakage is strategy, execution, or payer.

A board-ready view of financial risk, vendor performance, payer concentration, operational bottlenecks, and the highest-leverage fixes.

  • Board-ready summary of cash risk and revenue opportunity
  • Visibility into payer concentration and strategic exposure
  • Evidence for vendor oversight, acquisition diligence, or turnaround planning
CFO

Quantify recoverable revenue. Separate real bad debt from avoidable leakage.

Payer-by-payer cash performance, aging exposure, denial recoverability, underpayment patterns, write-off risk, and a claim-level queue ranked by expected value.

  • Recoverable revenue estimate with confidence bands
  • Aged AR segmentation by payer, status, and actionability
  • Underpayment, low-pay, and write-off detection
CMO

Find the clinical documentation patterns quietly costing revenue.

A clinical view of denial risk: medical necessity support, level-of-care documentation, treatment-plan alignment, signatures, attestations, note timing, and documentation behaviors that affect reimbursement.

  • Documentation gaps linked to financial outcomes
  • Clinician- or service-line-specific education themes when data supports it
  • Medical necessity and level-of-care defensibility review
CCO

Know where payer audit, SIU, and defensibility risks are building.

A structured view of audit exposure, payer investigation signals, documentation completeness, policy adherence, appeal evidence, and traceability.

  • Audit and SIU risk register
  • Documentation defensibility mapped to claims and payer behavior
  • Evidence trail for appeals, audits, and survey readiness
COO / VP RCM

Turn AR analysis into a work queue your team can execute.

The workflow view: claim owners, follow-up cadence, bottlenecks, payer response timing, denial routing, resubmission needs, and SLA breaches.

  • Prioritized claim work queue
  • Follow-up cadence and SLA gap analysis
  • Root cause routing by team and owner
Director of UR

Connect authorization and clinical review to revenue impact.

Authorization gaps, concurrent review issues, peer-to-peer timing, unfunded days, level-of-care support, and denials where stronger documentation or earlier escalation could have changed the outcome.

  • Authorization and concurrent review failure patterns
  • Level-of-care documentation feedback
  • Missed peer-to-peer and appeal window visibility
Denials

Denial analytics that explain both the RCM failure and the documentation failure.

A denial is rarely just a code. It is usually the visible endpoint of an upstream breakdown: eligibility, authorization, timely filing, coding, payment posting, payer policy, or clinical documentation. We classify denials across both dimensions so the right team owns the right fix.

CategoryCARC codes (illustrative)Synthetic 30dRecoverabilityHow Adentris catches it
Credentialing / enrollment CO-B7 · CO-256 $144,138 Prevent · partial retro Confirm provider is active and enrolled with the payer for the DOS before submit; hold and route to enrollment if not.
Authorization / precert CO-197 · CO-39 · CO-198 · PR-243 $81,524 High Flag auth-required services pre-submission; confirm auth on file or open the auth task. Auto-build the appeal for wrongly-denied auth-exempt crisis services.
Duplicate submissions OA-18 · CO-18 · PI-B13 $47,144 Rework only Detect duplicates before send. Dollars are not new revenue (original usually paid), but rework and AR delay disappear.
Coding CO-4 · CO-189 · CO-151 · CO-97 $12,531 High Modifier, units, NCCI and unlisted-code checks pre-submission. Map unlisted to payer-accepted HCPCS before billing.
Documentation / info CO-251 · CO-16 · CO-226 $11,969 High Confirm required attachment and documentation is present and complete before the claim is submitted.
Eligibility / COB PR-27 · OA-23 · CO-109 · CO-22 $7,847 Partial Eligibility and coordination-of-benefits check at intake; route to the correct payer or bill the secondary.
Reconsideration upheld CO-193 $7,748 Low Already appealed and denied again. Hardest bucket. Track to closure; prevent the root cause upstream.
Timely filing CO-29 $6,312 Lost · prevent forward Per-payer filing clock with alerts before the window closes. These dollars are gone; the control stops the next ones.
Other / misc adjustments CO-129 · CO-50 $234 Mixed Small miscellaneous payer adjustments; monitored, individually low value.
Total beyond write-off $319,447 Synthetic 30-day preview. Excludes contractual write-off and patient responsibility. Real engagements use your CARC totals.
“

Denial management improves when finance, billing, clinical, and compliance teams stop looking at separate reports and start looking at the same root cause map.

Continuous monitoring

Stop discovering payer and documentation problems after the quarter closes.

The ad hoc audit gives leadership a fast snapshot. Continuous AR Insights turns it into an operating system. Adentris monitors claim status movement, denial patterns, payer response times, AR aging, underpayments, authorization risk, and documentation quality on a recurring basis so teams can intervene earlier.

Payer trend alerts

Detect sudden shifts in payment rate, denial rate, response time, low-pay behavior, or audit activity by payer.

Denial root-cause trendlines

Watch denial reasons by payer, service line, clinician, location, or documentation theme. Route recurring issues to the team that can prevent the next denial.

AR aging velocity

See whether claims are moving toward payment, appeal, escalation, or write-off. Identify stuck claims before they become old claims.

Documentation quality monitoring

Track medical necessity support, level-of-care documentation, missing signatures, late notes, and treatment-plan gaps before claims leave the building.

Recovery work queue

A live list of the claims most worth working, with next action, owner, expected value, and deadline.

Executive reporting

Monthly view of cash risk, denial prevention, payer behavior, documentation quality, and progress against recoverable revenue.

Data

Start with what you have.
The audit sharpens as the data gets richer.

The fastest audit can begin with common billing and AR exports. More complete files allow deeper denial root-cause analysis, more precise recoverable revenue estimates, and stronger clinical documentation findings.

You do not need perfect data to start. If denial codes, write-off logs, or clearinghouse reports are missing, the audit will identify that as a revenue integrity finding and show what is being lost because the data is not captured.

Minimum for 3-day audit
  • Claim detail (ID, payer, DOS, billed/paid/balance, status, service line)
  • AR aging report
  • Payment posting or EOB/ERA summary
  • Denial statuses or denial report
  • Payer list and known network status
High-value additions
  • 835/837 files or CSV equivalents
  • CARC/RARC denial codes and dates
  • Adjustment and write-off transaction log
  • Clearinghouse rejection report
  • Authorization and concurrent review logs
  • VOB and eligibility verification logs
  • Expected reimbursement schedule or contract terms
  • Payer correspondence, audit letters, SIU correspondence, appeal history
  • Chart samples, clinical notes, treatment plans, discharge summaries, or EHR access
Why Adentris

Revenue integrity only works when claim data and chart data are connected.

Traditional AR reports stop at the billing system. Traditional documentation reviews stop at the chart. Adentris connects both. The platform reads claims, denials, payer responses, and clinical documentation, then routes findings to the right team: finance, RCM, clinical, utilization review, or compliance.

Preventable revenue leakage rarely belongs to one department. A denied claim may need a billing correction, a clinical note amendment, a utilization review escalation, a payer appeal, or a compliance response. AR Audit and Insights shows which one.

  • Fast start from existing exports. No multi-month implementation.
  • Combined financial, operational, and clinical documentation analysis.
  • Denial root-cause clustering tied to recoverability and owner.
  • Payer scorecards that support executive decisions and contract conversations.
  • Claim-level work queues, not just summary charts.
  • Optional continuous monitoring across AR, denials, payer trends, and documentation quality.
  • Built for regulated healthcare environments, including BH and SUD programs.
Trust

Built for regulated healthcare data.

AR Audit and Insights is designed for healthcare environments where PHI protection, audit trails, and secure data handling are mandatory. Fast analysis should not mean loose data handling.

  • SOC 2 Type I & Type II
  • BAA-ready (HIPAA)
  • 42 CFR Part 2 architecture
  • Microsoft Azure BAA
  • PHI never sent to external LLM APIs
  • Role-based access & audit logging
FAQ

Common questions.

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01 How fast is the audit?

First findings are delivered in under three days after Adentris receives the core data set. More complete data improves precision. The initial audit is designed to start from the billing, denial, payment, and AR exports most providers already have.

02 Is this a one-time project or ongoing software?

Both. The ad hoc AR Audit is a one-time snapshot of current performance. Continuous AR Insights uses the same analysis model on a recurring basis so leadership and operating teams can monitor payer trends, denials, AR movement, documentation quality, and recovery work queues over time.

03 What makes this different from an AR aging report?

AR aging shows how old balances are. AR Audit and Insights explains why balances are stuck, which claims are worth working, which denials are recoverable, which payers are changing behavior, and which documentation or workflow gaps are creating preventable loss.

04 Does this replace our RCM vendor or billing team?

No. The audit gives leadership independent visibility into how the revenue cycle is performing and gives RCM teams a prioritized work queue. Some providers use it to oversee a vendor; others use it to help internal teams focus on the claims and workflows that matter most.

05 Do we need an EHR or billing-system integration?

No integration is required for the first audit. Adentris begins with exported files. Continuous monitoring can also start from recurring exports, with deeper automation available when the organization wants it.

06 Does the audit include clinical documentation review?

Yes, when chart data or chart access is included in scope. Adentris connects denial and reimbursement issues to documentation quality, including medical necessity, level-of-care support, treatment plans, signatures, note timing, authorization support, and other documentation risks.

07 What data is required?

The minimum useful data set is claim detail, AR aging, payment or EOB/ERA information, denial statuses, and payer information. The audit becomes more precise with CARC/RARC codes, 835/837 files, adjustment and write-off logs, clearinghouse rejection reports, authorization logs, VOB records, expected reimbursement schedules, payer correspondence, and chart samples.

08 Can this help with payer negotiations?

Yes. The payer scorecard surfaces collection rates, payment behavior, denial trends, underpayment patterns, response timing, and concentration risk. That gives finance and executive teams evidence for payer escalation, contract discussions, and single-case agreement strategy.

09 Can this help with compliance or payer audits?

Yes. The audit identifies documentation defensibility issues, payer audit signals, SIU exposure, recurring patterns, and missing evidence. The goal is to help the provider understand where the record is strong, where it is weak, and what documentation or workflow controls need to improve.

10 What happens after the audit?

Use the report as a one-time recovery and improvement plan, give it to your RCM team or vendor, use it for leadership planning, or convert it into Continuous AR Insights for ongoing dashboards, alerts, and work queues.

11 Which provider types is this built for?

AR Audit and Insights is built for healthcare providers with meaningful claim volume and revenue integrity risk, including hospitals, health systems, behavioral health organizations, SUD programs, specialty groups, and other providers managing complex payer relationships.

Find the leaks. Prioritize the dollars. Fix the workflow.

AR Audit and Insights gives CEOs, CFOs, CMOs, compliance leaders, and RCM teams the same fact base, so the organization can move from reporting AR to controlling it.

Run a 3-day AR audit