Here’s what 2B real-world claims tells us about payer response times and expected reimbursement timelines.
In healthcare revenue cycle management, timing is everything. How quickly claims are resolved directly impacts your cash flow, operations, and ability to serve patients. To help clinics, physician groups, and digital health companies better understand payer response times, Cair Health leveraged our proprietary dataset of over 2 billion real-world claims. Here’s what we found:
What This Means for Your Practice
This data provides a clear picture of how claims progress through the payment pipeline:
- Early resolution rates are low: Only 4.3% of claims are resolved within the first three days, and most don’t see meaningful progress until day 10. This highlights the importance of submitting accurate, clean claims the first time to avoid denials or delays. A high first-time pass rate minimizes resubmissions and ensures claims enter the queue faster.
- A predictable cadence emerges: By day 10, over 42% of claims are resolved, and by day 30, nearly 96% of claims are paid out. This consistency provides a reliable benchmark for forecasting cash flow. However, if your claims are falling behind these timelines, it may signal inefficiencies in your billing workflows, such as delays in charge entry, eligibility errors, or insufficient payer follow-ups.
- The final stretch matters: Although most claims are resolved within 30 days, the last 4% often take weeks or months to close. These lingering claims can create unnecessary administrative burdens and delayed revenue. Automating claims tracking and denial management is critical for reducing long-tail collections.
Furthermore, our analysis reveals that these benchmarks hold steady regardless of claim reimbursement amounts—whether it’s $1,000, $5,000, or $10,000 per claim, the distribution remains largely consistent.
How Cair Health Accelerates Reimbursements
Cair Health’s AI-powered platform takes the guesswork—and the legwork—out of the claims process. Here’s how we help you stay ahead:
- Optimize claims for payer-specific rules: With insights from 2 billion claims, our system adapts in real time to changing payer policies, ensuring clean claims on the first submission.
- Leverage advanced LLMs: Our AI tools process and submit thousands of claims per minute while identifying patterns that reduce denials and delays.
- Streamline denial management: Denied claims are automatically flagged, prioritized, and corrected, reducing turnaround time for appeals and adjustments.
- Actionable insights: Our analytics platform gives you visibility into your billing performance, helping you identify bottlenecks and opportunities to improve.
If you are interested in learning more about how Cair Health can automate your RCM workflows, please book a demo and give us a follow on LinkedIn!
