Claims are routed efficiently by most RCM automation platforms, but they’re assigned poorly.

When a claim is dropped from the automated path, it typically lands in a shared work queue sorted by date or balance. Whoever has capacity picks up the next one.

That sounds reasonable, and it eliminates the one asset that actually resolves exceptions: familiarity with the insurer on the other end.

A denial from a regional payer with an unpublished documentation requirement will take forty minutes to resolve the first time. It’ll take eight minutes the fifth time, as long as the claim is worked by the same person.

Rotate the queue and every single claim becomes somebody’s first encounter.

That pattern repeats across every accounts receivable follow-up function organized around availability, not assignment.

Think of this scenario: one biller calls an insurer and gets a reference number. Two weeks later, the same claim is picked up by a different biller who starts the entire conversation over because the reference number is buried in someone else’s notes.

Nothing about this is negligent. The system just rewards speed of pickup over depth of knowledge.

Every exception carries a deadline, and the ones requiring the most work are governed by the same deadline as the ones requiring the least.

Denial volume is making this worse. Experian Health's 2025 State of Claims survey found that 41 percent of providers now report denial rates above 10 percent, a figure that stood at 30 percent just three years earlier. Sixty-eight percent said producing clean claims had grown harder over the prior year.

Capacity to work the queue has not grown at the same rate, and the effect shows up in how long revenue sits uncollected. MGMA’s benchmarks put the median practice at 47 days in A/R, with better performers at 36.

That eleven-day gap is driven largely by claims stuck in follow-up, the same unresolved exceptions that no one owns and no one escalates.

In a functioning denial management workflow, escalation is triggered by the clock. In most organizations, it is triggered by the balance. A $4,000 claim at day 20 gets picked up first because the amount is large, even though it has seventy days of filing runway left.

A $400 claim at day 80 stays in the queue because the balance looks small, even though it is ten days from becoming unrecoverable. The $4,000 claim would have been fine either way. The $400 claim needed to be worked first, and it was not.

Revenue that was never posted can’t appear as revenue lost.

When a claim expires past its filing deadline, the balance is written off under a category like ‘timely filing adjustment.’ That category is the same one used for routine contractual adjustments that were always expected.

Both end up on the same line in the same monthly report, which means a preventable loss looks identical to a planned one. No one is required to approve each write-off individually, so no one investigates why the claim expired in the first place.

According to HFMA, up to 65 percent of denied claims are never resubmitted at all, which suggests this is a default outcome.

Compare that with a denial that gets appealed and lost. Even a lost appeal produces a documented reason, which means the organization can trace what went wrong and update its processes to prevent the same denial on future claims.

A claim that simply expires is never examined. No reason is recorded, and no one changes the process behind it. The same failure will repeat itself, and no one will know it already happened before.

The exceptions hardest to resolve are the ones most likely to age out. That means the write-off pile is full of exactly the claims that would have revealed the most about which payers are problematic and which scrubber rules are missing.

The share of claims handled by claims processing automation keeps growing, which means the leftover pool is becoming a higher concentration of difficult cases. Staffing and attention given to that pool have not increased to match.

The 2025 CAQH Index reports that an estimated $258 billion in administrative costs was avoided by US healthcare during 2024 through electronic transactions. A remaining $21 billion in savings is locked inside transactions that are still manual or only partly automated.

Electronic adoption for medical attachments actually dropped, falling to 24 percent from 32 percent the year before.

Claim submission is now nearly universal electronically. The transactions that require a document, a phone call, or a clinical judgment stayed roughly where they were.

One thread connects all six rows. Each one requires context that is not stored anywhere in the system.

Every billing team has somebody who knows that a specific insurer rejects a particular modifier combination for reasons that were never documented. That person is also the one who takes two weeks off in July.

Every problem described above can be fixed by changing how RCM automation exceptions are organized.

The fourth point is the only one that shrinks the queue permanently. If a denied claim is resolved but the scrubber rules that let it through are never updated, the same denial will keep occurring on future claims.

The denial management workflow fixes the symptom once. The rule update prevents it from recurring.

One person should be assigned to review resolved exceptions monthly and convert the top five recurring causes into scrubber rules. The queue should get smaller over time. If it does not, the fixes are not making it into the system.

Experian Health’s same survey found that 62 percent of providers describe themselves as well-versed in automation and machine learning, but only 14 percent have actually deployed it.

That means the vast majority of exception handling work that could benefit from better tooling is still being done entirely by hand, in organizations that believe they are further along than they are.

Centro fills that gap. Our teams work inside your EHR, not a parallel system, so the claim history, the call notes, and the record of yesterday's conversation with the insurer are all held in one place.

Nothing is toggled between platforms, and no ticket is sent back to your office asking someone else to make the call.

The same team stays with your account for the length of the engagement. The person who learned an insurer’s documentation quirk in March is still working with that insurer in November, and in November they are faster.

Insurers are contacted directly on your behalf so your staff never receives a follow-up request routed back to their desk.