Solutions for Revenue Cycle Directors

From Claim Submission to
Payment — Every Step Measured

Clean claim rates, denial root causes, first-pass resolution rates, and payer contract performance are all measurable — but most organizations don't measure them until cash flow forces the question. Vizier makes these metrics visible before they become problems.

See a Live Demo →Revenue Cycle Optimization
$500Kadditional collections from 1% clean claim rate improvement at $50M revenue organization
Claim Lifecycle Tracking

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.

Payment Timeline Benchmarks by Payer Type
Medicare (clean claim)
Statutory requirement
14 days
Medicaid (state-dependent)
Varies by state
20–30 days
Commercial — major national plans
Contract standard
25–30 days
Commercial — regional plans
Contract standard
30–35 days
Workers' Compensation
State regulated
30–45 days
Self-pay / patient balance
Collection benchmark
60–90 days
Denial Root Cause Analysis

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.

23%
Prior Authorization Required / Missing
PA denial volume by payer reveals which payers have the most aggressive PA requirements — and whether your PA team is submitting on time.
18%
Medical Necessity Not Established
Diagnosis code and documentation mismatch — often addressable through provider education and documentation templates.
15%
Eligibility / Coverage Terminated
Eligibility verification failures at point of service. Real-time eligibility checks prevent the majority of these.
12%
Duplicate Claim Submission
Often a billing system or clearinghouse configuration issue — fixable at the source once the pattern is identified.
11%
Timely Filing Exceeded
These denials represent permanently lost revenue. Tracking by payer identifies which timely filing windows are most frequently missed.
9%
Coding / Modifier Error
CPT/ICD-10 mismatch or missing modifier. Provider education and pre-submission scrubbing reduces this category.
7%
Bundling / Global Period Violation
Procedure billed separately that should be bundled per NCCI edits. Pre-claim edits in your billing system address this.
5%
Other / Payer-Specific
Payer-specific billing requirements not met — requires payer manual review and contract-specific claim templates.
Clean Claim Rate & Collection Effectiveness

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.

Clean Claim Rate
> 95%
Every 1% = $500K at $50M org
First-Pass Resolution Rate
> 90%
Measures true no-touch payment rate
Collection Effectiveness Index
> 95%
Net collections vs. net collectible
Denial Overturn Rate
> 65%
Measures appeals process effectiveness
Days in AR (commercial)
35–45 days
Above 50 = cash flow risk signal
AR > 90 Days
< 15% of AR
Aging above this signals collection failure
95%+
Industry benchmark clean claim rate — below this means significant rework cost and delayed cash flow
$500K
Additional collections from 1% clean claim rate improvement at a $50M revenue organization
25–35
Days to payment for commercial payers — Medicare averages 14 days for clean claims
65%
Of denied claims are never resubmitted — representing permanent revenue loss
Related Solutions

Revenue Intelligence Across the Financial Team

Revenue Cycle Optimization
End-to-end revenue cycle analytics from E&M code accuracy through denial management and payer contract performance.
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Healthcare CFO Analytics
Revenue leakage detection, value-based care financial modeling, and payer mix analysis for hospital financial leadership.
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Care Gap Revenue
Quantify the AWV, CCM, RPM, and screening revenue sitting in your patient panel — not just denials from submitted claims.
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Denial Management Clarity

Find What's Being Left on the Table in Your Claims

Upload a claims data export and see your clean claim rate, denial root cause distribution, and payer payment timeline performance — without building a report or waiting for an analyst.

Ask Your Vizier →Talk to a Revenue Cycle Analyst