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How to Recover Old Unpaid Therapy Insurance Claims

A practical guide for therapy and behavioral health practices with claims stuck in A/R

Almost every practice that takes insurance has a pile of claims nobody has looked at in months: denials no one had time to appeal, claims the payer never answered, and rejections that were never resubmitted. Some of that money can still be collected. Some can't. The key is to sort it quickly and work what's still recoverable before more deadlines pass.

Step 1: Pull an aging report

Run an unpaid claims or A/R aging report from your EHR or billing system, broken down by payer and by age (0–30, 31–60, 61–90, 91–120 and 120+ days from date of service). Include the claim status, the last action taken and any denial codes.

If your system shows a claim as "submitted" but there is no payer response, treat it as unknown until you have confirmed the payer actually received it.

Step 2: Check each payer's deadlines

Two deadlines decide what is still workable:

• Timely filing limit: how long after the date of service the payer will accept an original claim. It varies by payer and contract. For Medicare it is generally 12 months from the date of service. Commercial and Medicaid plans set their own limits, which can be much shorter, so check your contracts and payer manuals.
• Appeal or reconsideration deadline: how long after a denial you can dispute it. For Medicare, a first-level appeal (redetermination) generally has to be filed within 120 days of receiving the initial determination. Commercial plans list their deadlines in the denial letter or provider manual.

Mark every claim as inside deadline, close to deadline or past deadline.

Step 3: Sort by status

• Never received by the payer (rejected or lost): correct and submit, and gather any proof of timely submission, such as clearinghouse acceptance reports.
• Denied for a fixable error: send a corrected claim or a reconsideration.
• Denied on coverage, authorization or medical necessity: decide whether an appeal is supported by the documentation.
• No response: check the payer portal or call for claim status, and resubmit if the payer has no record.
• Underpaid: compare the payment with your contracted rate and request a review.
• Patient responsibility: send statements if the balance belongs to the client.

Step 4: Work in priority order

Start with claims closest to their deadline, then work through by value. Batch similar claims by payer and denial reason, because one fix often applies to many claims, for example a credentialing effective date or a wrong telehealth modifier across several months.

Step 5: Document everything

For every claim, record what was done, when, the reference number of any call, and the next follow-up date. If you need to prove timely filing or a prior appeal later, this is your evidence.

Step 6: Be honest about what can't be recovered

Claims past both the filing and appeal deadlines, with no proof of timely submission, usually can't be collected from the payer. Depending on your contract, you may not be allowed to bill the client for them either. Write them off properly so your A/R reflects reality, and look at why they aged out so it doesn't happen again.

Step 7: Stop the backlog from rebuilding

• Work rejections within days, not weeks
• Review every remittance for denials as it is posted
• Follow up on any claim with no response after 30 days
• Track authorizations and re-verify coverage regularly
• Review A/R over 60 days monthly

Our guide on behavioral health denial management sets out a simple workflow for this.

Want us to do it for you?

MedBill Solutions works old unpaid claims for therapy and behavioral health practices across the US. We'll work your old unpaid claims and you only pay 3% of what we recover. If nothing is recovered, there's no recovery fee. We start with a review of your aging report, tell you which claims are still workable and why, and report back on every claim.

We sign a Business Associate Agreement (BAA) before we see any patient information, and we work inside your existing EHR or billing system. See how the old claims service works or send us a message below. We reply within one business day.