Backlog condition
Know whether a queue is temporary, growing, recovering or persistently overloaded.
CRIS RCM
Revenue does not usually disappear all at once. It gets stuck one claim, one delay and one missed follow-up at a time.
By the time the problem becomes obvious in the financial results, the operational delay may already have been building for weeks.
CRIS RCM helps revenue-cycle teams see where work is moving, where it is slowing down, what is waiting for attention and what should happen next.
Needs Attention126+18 since yesterday
Overdue Follow-ups3811 high value
New Denials24$186K exposure
A/R 90+ Days$412K76 accounts
Needs Attention TodayPriority order
1
Appeal deadline approachingAetna • Claim CLM-48219 • $42,800
Due today2
Follow-up overdueUnitedHealthcare • 14 days overdue • $31,400
Overdue3
Claim stalled after submissionBlue Cross • No movement for 21 days • $18,750
Review4
Ageing balance without recent actionCigna • 94 days • $15,920
AssignSee the workKnow what exists right now.
See the movementKnow whether it is progressing.
See the delayKnow where work has slowed down.
See the responsibilityKnow who owns the next action.
See the resultKnow whether it was resolved.
Movement, not just status
See where a claim stopped moving.
A status tells you where something is. Movement tells you whether anything is happening.
Two claims may both show as “pending.” One may have become pending this morning. Another may have been sitting there for 45 days.
See the journey of a claim, not just its final status.Created → Submitted → Accepted → Processed → Paid.
Know how long an item has been in that stage.Time in status makes delay visible.
Know who owns what happens next.Responsibility stays connected to the work.
Original claim$42,800
Current statusDenied
Age32 days
1CreatedAug 17
2SubmittedAug 18
3AcceptedAug 19
4DeniedSep 02
5ReviewWaiting 16 days
6ResolutionPending
Where it stoppedDenied → ReviewNo action recorded since September 2. Appeal window closes in 2 days.
What should we deal with first?
See today’s workload without losing sight of tomorrow’s problem.
Revenue-cycle teams do not need another dashboard they have to interpret every morning. They need to know what needs action.
PriorityWork itemPayerOwnerDueValue
CriticalAppeal deadline approachingAetnaEmily CarterToday$42,800
HighFollow-up overdue 14 daysUnitedHealthcareMichael BrooksOverdue$31,400
HighNew denial requiring reviewBlue CrossSarah MitchellTomorrow$18,750
NormalA/R follow-up dueCignaDaniel ReedSep 20$15,920
38Overdue follow-ups
$286KAssociated balance
14 daysOldest overdue item
Commercial Payers16
Government Payers12
Denials & Appeals7
Payment Review3
24New denials
$186KDenied value
8Appeal candidates
Missing information9
Authorization6
Coding5
Eligibility4
$412KA/R 90+ days
76Accounts
21No action in 14+ days
0–30$773K31–60$423K61–90$239K90+$405K
Open workOverdue work
Open backlog552+31% over 8 weeks
Overdue work91+117% over 8 weeks
Median turnaround6.8d+1.9 days vs W1
Where the work is concentratingCurrent open items
UnitedHealthcare118
Blue Cross96
Aetna77
Cigna57
Denials, A/R and follow-up
Turn unresolved revenue into manageable work.
Denials should become work, not just statistics. A/R should tell you where follow-up effort is needed. Follow-up should not depend on someone remembering.
See which denials keep coming back.Move from “Work the denial” to “Why do we keep getting this denial?”
Older accounts should become harder to ignore.Age plus operational history is more useful than age alone.
See the difference between “waiting” and “forgotten.”Preserve whether the team is waiting on a payer, documentation, review or no recent action.
Know which payers are creating the most operational work.Compare backlog, denials, follow-up demand and response times.
From signal to accountable action
A dashboard should trigger the next action.
If the system says 87 overdue follow-ups, the immediate questions are: Which ones? How overdue? How much money is involved? Who owns them? What should happen next?
SignalSee where work is late, growing, recurring or unusually old.
ContextUnderstand payer, facility, value, age, stage and recent activity.
OwnerMake current responsibility and next action visible.
OutcomeTrack progression through resolution and closure.
Management ExceptionsRequires attention
01
Overdue follow-up backlog +42%Commercial Payers • 38 items • $286K
Escalated02
Blue Cross denial rate risingMissing information now 37% of new denials
Investigate03
A/R 90+ days increasing$412K • 21 accounts without action in 14+ days
Review04
Appeal queue near capacity8 deadlines within 3 business days
ReassignOperational accountability
Reduce the “Who is handling this?” problem.
The answer should not require a chain of phone calls. CRIS RCM can help make responsibility visible.
Current ownerTeamAssigned dateDue dateCurrent statusRecent actionNext action
One claim. One history. Different operational views.
OwnerEmily Carter
StatusIn Progress
Next actionSubmit appeal
DueSep 19
Sep 02Denial receivedMissing supporting documentation
Sep 03Assigned to Emily CarterHigh priority • 3 business day review target
Sep 04Documentation requestedWaiting for clinical documentation
Sep 06Follow-up reminder triggeredDocument still outstanding
Sep 18Documentation receivedAppeal ready for submission
Operational intelligence that supports management
See today’s workload and the patterns creating tomorrow’s backlog.
Turnaround time
See where time between submission, denial review, follow-up, appeal and resolution is increasing.
Recurring patterns
Identify denial reasons, payers, facilities and process conditions that keep creating work.
Workload context
Understand whether delay is being driven by capacity, process, concentration or another operating condition.
Escalation
Carry the reason, value, age, history and context when work requires management attention.
Operational history
See what happened before asking what went wrong, including actions, reassignment, follow-up and closure.
CRIS RCM operating picture
CRIS RCM brings operational revenue-cycle control together.
The goal is not to make teams stare at more screens. It is to make unresolved work harder to miss.
Open work552+31% in 8 weeks
Overdue9116.5% of open work
Denial work11724 new today
90+ day A/R$412K76 accounts
Median turnaround6.8d+1.9 days
Open workOverdue work
Requires AttentionTop signals
1Overdue follow-ups increased 42% in Commercial Payers.
2Missing-information denials are repeating across two facilities.
321 aged accounts have no action recorded in the last 14 days.
Operating modelSee the workSee the movementSee the delaySee the ownerSee the result
Revenue-cycle work should not disappear between systems and people.
Stop managing yesterday’s backlog with today’s spreadsheet.
CRIS RCM helps create a clearer operating picture: What is waiting? What is late? What is repeating? What is ageing? What is blocked? Who owns it? What should happen next?
Because revenue-cycle teams should not have to discover their biggest problems after those problems have already become financial results.