AR Analyst Process: How to Work an Account, Prepare Notes & Handle Non-Callable Denials
Medical billing Accounts Receivable (AR) analysts play an important role in ensuring that healthcare providers receive payment from insurance companies. To work any account effectively, AR analysts generally follow three key phases:
Analysis
Research
Action
Understanding these phases will help you work accounts correctly, resolve denials faster, and document proper notes.
1. Analysis Phase
The Analysis phase is the first step when working on an account. In this phase, you determine the current status of the claim.
Key Steps in Analysis
- Check if EOB is available
Verify if an EOB (Explanation of Benefits) is posted in the system.
If the account contains a denial, there will usually be an EOB attached. - Check the Clearinghouse
If the claim shows no response, check the clearinghouse portal.
Sometimes EOBs or rejections appear in the clearinghouse before they are posted in the system. - Review Previous Notes
Always check previous work notes.
This helps you understand:
Whether someone already worked the account
What actions were taken earlier
What the next step should be
The goal of this phase is to clearly understand the current claim status before taking any action.
2. Research Phase
Once the claim status is identified, the next step is Research.
During this phase, you gather additional information using:
Insurance websites/portals
Phone calls to insurance representatives
Internal AR scenarios or workflows
Sometimes you can resolve an account without calling the insurance.
Example:
If the denial is coding-related, you can directly assign the claim to the coding team.
Important Tip
Always keep the AR Scenario Guide open while working.
This helps you ask the right questions when speaking with insurance representatives.
Example Scenario 1: Claim Not on File
Analysis
No EOB found in system
No EOB in clearinghouse
Claim not rejected
No previous notes
Research
You must check claim status using:
Insurance website, or
Phone call to insurance
If Calling Insurance
You may hear the response:
“Claim is not on file.”
Then verify the following:
Policy effective date
Policy termination date
Whether DOS (Date of Service) falls within coverage
Timely Filing Limit (TFL)
Claim mailing address
Payer ID
Fax number
Call reference number
Example Call Information
Policy effective date: 01/01/2020
Policy status: Active
DOS: 02/05/2021
TFL: 365 days
Fax number: 1234567890
Call reference: 12345
Action
Since the claim was not received by insurance and is within TFL, the correct action is:
Resubmit the claim to the insurance company.
Preparing AR Notes
AR notes must always include three parts:
Analysis
Research
Action
Example Call Notes
Analysis
Checked system – no EOB found. Checked clearinghouse – no EOB available.
Research
Called insurance and spoke with Maria. As per the representative, the claim is not on file. Patient policy effective date is 01/01/2020 and still active. TFL is 365 days. Claim mailing address and payer ID match the system. Fax number 1234567890.
Action
Claim resubmitted to insurance. Call reference number 12345.
Example Scenario 2: Denial Code 26
Denial Reason
26 – Expenses incurred prior to coverage
Analysis
EOB available in system
Claim denied with code 26
No previous notes
Research
Verify:
Denial date
Policy effective date
Policy termination date
Whether DOS falls within coverage
Whether other insurance exists
Example Information
Denial date: 05/31/2021
Policy effective date: 01/01/2020
Policy terminated: 12/31/2020
DOS: 03/28/2021
Here, DOS is outside coverage period, meaning the policy was not active.
Action
Next steps:
Check if another insurance policy exists
If another insurance is active → Bill the secondary insurance
If no insurance exists → Release claim to patient
In this case:
No other insurance found → Claim released to patient.
Final Example Notes
Analysis
Checked system – EOB available. Claim denied with code 26 – Expenses incurred prior to coverage.
Research
Called insurance and spoke with Maria. As per the representative, claim denied on 05/31/2021. Policy effective date 01/01/2020 and terminated 12/31/2020. No other active insurance available.
Action
Since coverage inactive on DOS, claim released to patient. Claim #2586. Call reference #1234.
Non-Callable Denials
Some denials do not require calling the insurance company. These are called Non-Callable Denials.
However, always check your client-specific guidelines, as some clients may still require calls.
1. Eligibility Denials
These denials are usually related to insurance eligibility issues.
Common examples:
31 – Patient cannot be identified as insured
26 – Expenses incurred prior to coverage
27 – Expenses incurred after coverage terminated
22 – Covered by another payer (COB issue)
109 – Claim sent to wrong payer
140 – Patient ID and name mismatch
MA04 – Secondary payment requires primary payer information
Most eligibility denials can be resolved by checking the insurance portal.
2. Coding Denials
Coding denials occur when procedure codes, diagnosis codes, or modifiers are incorrect.
Examples:
4 – Procedure code inconsistent with modifier
6 – Procedure code inconsistent with patient age
7 – Procedure code inconsistent with patient gender
9 – Diagnosis inconsistent with patient age
10 – Diagnosis inconsistent with patient gender
11 – Diagnosis inconsistent with procedure
49 – Non-covered routine service
146 – Invalid diagnosis for DOS
181 – Procedure code invalid for DOS
182 – Modifier invalid for DOS
These claims are usually assigned to the coding team for correction.
Final Thoughts
Working AR accounts becomes easier when you follow the structured approach:
- Analysis → Understand the claim status
- Research → Gather correct information
- Action → Take the appropriate resolution step
Always remember:
Check EOB
Review clearinghouse
Verify eligibility
Follow AR scenarios
Prepare proper notes
Following this process helps AR analysts resolve claims faster, reduce denials, and improve revenue cycle efficiency.
