Mid-Size Ohio Health System Untangled $22M in Legacy AR with Annexmed

Overview

In 2024, a health system in central Ohio, two community hospitals, a specialty surgical center, and 25 outpatient clinics, found itself in financial limbo. With 450 providers and a payer mix spanning Medicare, Medicaid, Ohio BWC, and major commercial carriers, its revenue cycle operations were stretched thin.x

The source of the pain wasn’t new revenue, it was old revenue stuck in limbo. After a merger and a migration from Allscripts to Epic, the health system carried $22M in unresolved AR, nearly half of which was already over 180 days old.

Challenges

Like many health systems navigating EHR transitions and payer complexities, the client encountered roadblocks that disrupted cash flow and slowed recovery efforts. What appeared as routine operational hurdles soon revealed deeper revenue cycle issues. The following challenges highlight the critical gaps that surfaced, each demanding a tailored strategy to restore efficiency and financial stability.

Denials with No Clear Path Forward

Ohio Medicaid MyCare denials tied to outdated coordination-of-benefits (COB) data. Medicare claims denied under CARC 109 (“Not covered by this payer/contractual obligation”) and CO-197 (“Precert/authorization required”).

Stranded Balances in Multiple Systems

Claims frozen in Allscripts after the Epic migration. Mapping mismatches meant adjustment codes didn’t carry over properly.

Underpayments Hidden in Plain Sight

Anthem and Medical Mutual contracts weren’t loaded correctly in Epic. The system was accepting payments that were systematically lower than contracted rates.

The Small-Balance Trap

Almost 20% of accounts were under $250. Chasing them cost more than their recovery value, but there was no clear policy to adjust or close them out.

AnnexMed’s Approach

Building One Source of Truth

Pulled open AR from Epic and Allscripts into a centralized reporting warehouse.
Stratified accounts by payer, age, balance, and denial type.
Created a dashboard that ranked claims by likelihood of recovery instead of raw balance.

Attacking Payer Pain Points

Medicare & Ohio Medicaid

Enrollment success hinges on precision. We organize and submit the required documents, anticipate payer bottlenecks to move you in-network quickly.

Commercial Payers

We create, update, and maintain your CAQH and PECOS profiles to ensure faster payer approvals and up-to-date provider records avoiding any delays.

Ohio BWC (Workers’ Comp)

We proactively manage re-attestations, renewals, and payer revalidations so your provider status stays active without last-minute disruptions.

Automating the Grind

RPA bots scraped ERA/EOB data from payer portals.
Denial codes like CO-18 (duplicate claim/service) and OA-23 (payment adjusted due to impact of prior payer adjudication) were auto-matched and flagged for resolution.
CFO-approved small-balance thresholds (<$50 auto-adjust, <$200 manual review) freed staff from low-value work.

Escalating High-Value Claims

High-dollar accounts (> $20K) were isolated and escalated directly with payer representatives.
Progress was tracked with weekly KPI dashboards showing recoveries by payer, age bucket, and denial type.

Solution Impact

$5.06M

Recovered from legacy AR

12%

Clean claim rate improved

25%

Improved in staff productivity

45%

Reduction in AR >180 Days

Ready to Get Started?

Whether you need full-scale support or help with just one part of the revenue cycle, AnnexMed offers modular services tailored to your most pressing needs.

Let's get started with,