We run billing from the eligibility check to the final payment: claims out clean, rejections worked within days, every payment checked against your contract, inside the EHR you already use.
Medical billing
Most billing losses are not dramatic. They are claims that went out a week late, rejections nobody opened, and payments posted without anyone checking the amount. Each one is small, and together they set your collection rate.
Plans change, members move and IDs go stale. A claim built on old coverage is denied before anyone looks at the medicine. In one engagement, front-desk eligibility caused 70 percent of the denials.
A rejected claim was never accepted by the payer, so it usually does not count as filed. It waits in the clearinghouse queue while the filing window runs out.
Every day between the visit and the claim comes off the filing window and adds to days in AR. Lag is easiest to see by provider and by location.
A remittance that pays less than the contract gets posted and closed. Underpayments only surface when someone compares the allowed amount with the fee schedule.
Once the primary pays, the secondary claim and the patient statement still have to go out. Both slip when the queue is long.
Claim cycle
A claim passes through seven steps between the schedule and the bank. We own each one, and each has its own way of failing.
| Step | What happens | Where it usually fails |
|---|---|---|
| Eligibility | Coverage, plan and benefits checked before the visit (X12 270/271) | Checked once at booking, or not at all |
| Charge entry | Codes, modifiers and diagnoses taken from the note and reviewed by a certified coder | Entered days late, or ahead of the documentation |
| Claim scrub | Payer rules, NCCI code pairs and unit limits checked before the claim leaves | Edits left for the payer to find |
| Submission | Claim sent through the clearinghouse (X12 837P) | Wrong payer ID, or a member ID that changed |
| Acknowledgment | Clearinghouse and payer accept or reject the claim (277CA) | Rejections left in the queue, so the claim is never filed |
| Adjudication | The payer pays, adjusts or denies, with reason codes on the remittance (835) | Denials treated as final, partial payments not questioned |
| Posting and follow-up | Payment posted, secondary claim sent, balance billed or worked | Underpayments closed, secondaries forgotten |
Denials have their own process, covered on the denial management page. Code selection and edits are covered on medical coding, and authorizations on prior authorization.
Deadlines
Claims must be filed no later than one calendar year after the date of service. The exceptions are narrow, such as an error by Medicare or its contractor, or retroactive entitlement, and each extends the deadline to the end of the sixth month after the notice.
The limit is whatever the contract says, and it is often much shorter than Medicare's year. In one engagement, a commercial payer's 90-day window had closed on most of the affected claims before anyone looked. For one payer worked through, see the BCBS Wyoming timely filing limit.
A claim rejected at the clearinghouse or at the payer's front door usually does not count as filed. The clock keeps running until a clean claim is accepted. Read how rejections affect timely filing.
When a payer says a claim never arrived, the clearinghouse acceptance report is the evidence. Without it on file, a late claim usually cannot be appealed, so we keep it for every claim.
Count down your own deadlines with the free timely filing countdown.
Source: 42 CFR 424.44
Reporting
We report these from your own system in Apex, our client dashboard, by payer and by provider. If your current billing company cannot show you all five, that is worth asking about.
| Measure | How it is worked out | What it tells you |
|---|---|---|
| Net collection rate | Payments divided by charges after contractual adjustments, for the same dates of service | How much of what you were owed you actually collected |
| Days in AR | Total accounts receivable divided by average daily charges | How long money takes to arrive |
| AR over 90 days | Share of open AR older than 90 days | How much is close to aging out |
| First-pass rate | Claims paid or correctly adjudicated on first submission, as a share of claims sent | How often claims go out right the first time |
| Denial rate | Claims denied as a share of claims adjudicated, by reason and by payer | Where the rework comes from |
To see how yours compare, try the AR aging benchmark comparator or the billing performance self-check. If AR over 90 days keeps rising, read why AR over 90 days climbs.
Switching
Most of the risk in a switch sits in the claims already out the door. Before the handover, someone has to own the open AR, the rejection queue and the credentialing files, in writing.
We start from an AR snapshot, so every open claim has an owner on day one, and work the open claims alongside the new ones. If you are leaving a billing company, read how to switch billing companies without losing money. If your biller has just left, start with what to do first when a biller quits.
Comparison
A process comparison, not a promise of outcome. It shows what changes in how claims are handled.
| Area | Before | With Quilven |
|---|---|---|
| Eligibility | Coverage checked at booking, or only after a denial. | Coverage verified before each visit, working with your front desk, and changes caught before the claim is built. |
| Charge lag | Charges entered when someone has time. | Charge lag tracked by provider, and claims out within days of the visit. |
| Claim edits | Payer edits found when the payer applies them. | NCCI pairs, unit limits and payer rules checked before submission. |
| Rejections | Rejected claims sit in the clearinghouse queue until the filing window closes. | Rejections worked within four to five days, while the claim is still recoverable. |
| Payment posting | Payments posted and closed whatever the amount. | Allowed amounts compared with the contract, and underpayments disputed. |
| Secondaries | Secondary claims and patient statements go out when someone remembers. | Secondaries and statements sent as soon as the primary posts. |
| Reporting | A monthly summary, weeks after the month closed. | Collection rate, AR aging and denials by payer in Apex, whenever you look. |
Which of these applies to your claims is a question the audit answers. Request the audit.
Case study
One AR recovery engagement, at a family medicine practice in Minnesota. Shown for method, because most of what went wrong there was billing, not medicine. Individual results vary. One engagement is not a forecast.
We reviewed 245 claims. The rejection queue had no owner, and some claims in it had waited close to a year.
Billed charges in that queue came to roughly $40,000 to $50,000, none of it being worked.
Most of the damage started before the claim was built. Stale coverage, incorrect member IDs and skipped eligibility checks at the front desk caused 70% of the denials.
Not everything could be reopened. On most of the affected claims, a commercial payer's 90-day window had already passed with no proof of submission on file, so appeals were not possible.
What came back was about $5,500, paid on 50 to 55 claims, most of it within 45 to 50 working days.
In their words
What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
I appreciate the professionalism, the courtesy, the knowledge.
After the audit the practice changed how it runs: eligibility verified before arrival, no more walk-ins, every patient checked the night before.
Pricing
Medical billing is 3 to 5 percent of collections, set by monthly volume, with a $500 monthly minimum. The same rates apply to every specialty. You can see pricing in full.
12 to 15%
of the recovered amount
No fee on what is not recovered. Where a practice lands in the range depends on claim volume, age of the inventory, and payer mix.
3 to 5%
of collections by monthly volume
A $500 monthly minimum applies. The rate moves with monthly volume, not with headcount on your side.
$150 to $200
per payer application
$200 per application, or $150 each on larger batches. Included in the billing percentage for billing clients.
Fit
Outsourcing your billing does not require a system swap. We integrate with 30+ EHRs and practice management systems and work inside the one you already have. No data migration, no parallel system, no change to how your staff enters a charge or checks a patient in. If your team is trained on your current software, that training stays valid.
This matters because the usual objection to outsourced billing is that it turns into an implementation project. It does not here. Quilven is a managed service, not software. There is no proprietary platform you are asked to adopt and no license to renew, so the engagement can start on the claims you already have rather than after a build-out.
What you do get is visibility. Apex is our client dashboard, and it shows in real time:
Apex reads the work we are doing in your system. It is a window, not a replacement, so if the engagement ends your records and workflows are exactly where they were.
Company
Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.
Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 to $200 per payer application.
The entry point is a free RCM audit. It takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.
We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick and works from 159 4th Ave N, Suite 100, Nashville, TN 37219. The entity is registered in Wyoming. Reach us at (202) 490-9406 or info@quilven.com.
Fit
Independent, physician-owned practices with 3 to 25+ providers, in any specialty we serve. Solo practices are welcome too.
It fits practices whose biller has left, whose billing company submits claims but does not work the denials, or whose AR over 90 days keeps growing. See how to check whether denials are being worked, or browse billing by specialty.
It is not for hospitals billing facility claims.
At a glance
FAQ
Sources
Checked 17 October 2026. Coverage policies and code rules revise without much notice, so confirm the current version before you rely on one.
Next step
The audit takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, plus the repeating root causes behind your denials. We only need aging totals to begin. No patient data, no contract, no obligation to work with us afterward. If your aging is healthy we will tell you that.
Answer three questions below and book a line-by-line audit of your claims.
Pick the one that hurts most. We start there.
A round number is fine. We verify it in the audit.
Just you, or a group. Either is welcome.
No patient data. We only need aging totals to start.
(202) 490-9406 · info@quilven.com · Book 15 minutes