How To
How To
How to Read Your Dental Practice Insurance Aging Report
Greg Hudnall
How To · 8 min read
Your insurance aging report shows which claims are stuck, and anything sitting past 90 days is usually where the money is quietly leaking.
Your practice management software has a report that shows you every outstanding insurance claim, organized by how old it is. It’s usually called the Insurance Aging Report, the Outstanding Claims Report, or the Claims Aging Summary. In accounting terms, this is your accounts receivable. In dental terms, it’s the money you’ve earned but haven’t been paid yet.
Most practice owners know this report exists. Fewer look at it regularly. Even fewer know what the numbers should look like or what to do when they don’t.
This post explains how to read the report, what healthy aging looks like, and what to do when claims are sitting too long.
What the Insurance Aging Report Shows You
The report lists every insurance claim your practice has submitted that hasn’t been paid yet. Claims are grouped into aging buckets based on how many days have passed since the date of service (or in some PMS systems, since the claim was submitted):
| Bucket | What it means | Action |
|---|---|---|
| 0 to 30 days | Normal processing window. Most claims are paid here. | No action needed. Monitor. |
| 31 to 60 days | Slightly slow. Should have been paid by now. | Check claim status with the carrier. |
| 61 to 90 days | Overdue. Likely held up, denied, or missing information. | Direct follow-up. Resubmit or appeal as needed. |
| 90+ days | At risk. Recovery rates drop the longer claims sit. | Aggressive follow-up. Escalate or write off after options are exhausted. |
The total of all outstanding claims is your insurance accounts receivable. For a practice producing $150,000 to $200,000 per month with insurance representing 60 to 70% of collections, it’s normal to have $80,000 to $150,000 in total outstanding claims at any time. The question isn’t whether you have outstanding claims. The question is how old they are.
What Healthy Aging Looks Like
A well-managed insurance aging report is front-loaded. Most of the money is in the 0 to 30 day bucket, a smaller amount is in the 31 to 60 day bucket, and very little is in the 60+ buckets.
Here’s what a healthy aging report looks like for a practice with $120,000 in total outstanding claims:
| Bucket | Amount | % of total |
|---|---|---|
| 0 to 30 days | $78,000 | 65% |
| 31 to 60 days | $24,000 | 20% |
| 61 to 90 days | $12,000 | 10% |
| 90+ days | $6,000 | 5% |
Only 15% of the total is over 60 days. This practice has most of its outstanding claims in the normal processing window, a reasonable amount working through the 31 to 60 day range, and only 15% in the overdue buckets. That’s manageable.
What Unhealthy Aging Looks Like
Here’s the same $120,000 in outstanding claims with a problematic distribution:
| Bucket | Amount | % of total |
|---|---|---|
| 0 to 30 days | $36,000 | 30% |
| 31 to 60 days | $30,000 | 25% |
| 61 to 90 days | $30,000 | 25% |
| 90+ days | $24,000 | 20% |
That is 45% of the total over 60 days. That’s $54,000 in earned revenue that’s either stuck in carrier limbo, denied and not reworked, or lost. Claims over 90 days have significantly reduced recovery rates, with recovery dropping sharply the longer they sit. This practice is likely losing $15,000 to $25,000 per year in revenue that could be recovered with better follow-up.
What Causes Claims to Age
Late claim submission
If claims aren’t submitted within 24 to 48 hours of the procedure, the entire aging timeline shifts. A claim submitted 2 weeks late starts in the 0 to 30 bucket already partially aged. Multiply that across hundreds of claims per month and your aging report shifts visibly.
Missing or incorrect information
Wrong subscriber ID, wrong date of birth, wrong carrier address. These errors cause claims to be returned or rejected. If the rejection isn’t caught and corrected quickly, the claim sits. Common culprits: outdated insurance information in the PMS, new patients whose insurance wasn’t verified before the appointment.
Pre-authorization issues
Procedures that require pre-auth (crowns, implants, some major restorative) can be denied if the pre-auth wasn’t obtained, has expired, or doesn’t match the procedure billed. These denials are usually fixable but require someone to identify them, gather the documentation, and resubmit.
Coordination of benefits (COB)
Patients with two insurance carriers create more complex claims. The primary carrier must process first, and the secondary carrier won’t process until it receives the primary EOB. If the patient’s COB information is wrong in either carrier’s system, both claims stall. COB issues are one of the most common reasons for claims in the 60 to 90 day bucket.
No follow-up process
This is the most common cause of claims in the 90+ bucket. The claim was submitted. It wasn’t paid. Nobody followed up. In practices without a dedicated insurance follow-up process, unpaid claims simply age until someone notices or until they’re written off.
How to Work Your Aging Report
The aging report is only useful if someone acts on it. Here’s a practical workflow:
Weekly: Review the 31 to 60 day bucket. These are claims that should have been paid by now. Check each claim’s status with the carrier (most carriers have online portals or phone lines for claim status). Identify whether the claim is in process, denied, or needs additional information. Resolve whatever is needed.
Weekly: Work the 60+ day bucket. These are overdue. Every claim in this bucket needs direct follow-up. Call the carrier if the online portal doesn’t show a clear status. Resubmit if necessary. Appeal denials that are fixable. Write off claims that are genuinely uncollectible after all options are exhausted.
Monthly: Review the overall aging distribution. Is the 90+ bucket growing? Is the 0 to 30 bucket shrinking as a percentage? Trends in the aging distribution tell you whether your collection process is improving or deteriorating.
Monthly: Identify carrier-specific patterns. If one carrier consistently appears in the 60+ bucket, there may be a systemic issue: wrong provider ID on file, incorrect fee schedule in the PMS, or a recurring documentation requirement you’re not meeting. Fixing the root cause clears the entire backlog for that carrier.
Patient Aging Is a Separate Problem
Everything above applies to insurance claims. Patient balances have their own aging report and their own dynamics.
Patient aging works the same way structurally (0 to 30, 31 to 60, 61 to 90, 90+ day buckets) but the collection probabilities are much worse. A patient balance at 30 days has maybe a 70 to 80% collection probability. At 60 days, it drops to 50 to 60%. At 90 days, 30 to 40%. At 120+, you’re looking at 20% or less.
The most important thing you can do for patient aging is collect at the point of service. Every dollar collected at checkout is a dollar that never enters the aging pipeline. After that, prompt statements (within 2 weeks of EOB), structured follow-up (phone call at 30 to 45 days), and a clear write-off policy for balances that have been through the full cycle.
What Your Accountant Should Track
A dental-specific accountant should be able to show you, at minimum:
- Total insurance AR and the distribution across aging buckets, trended monthly
- Total patient AR and the distribution across aging buckets, trended monthly
- Days in AR (average days from date of service to payment), trended monthly
- Your collection rate, both current-period and trailing
- Write-offs broken out by type: contractual adjustments (PPO write-offs) vs. bad debt (uncollectible patient balances) vs. insurance write-offs (denied claims)
If your current financial reporting only shows total deposits and doesn’t break out aging, collection rates, or write-off categories, you’re missing the data you need to manage your revenue cycle.
Frequently Asked Questions
How often should I review my insurance aging report?
Someone in your practice (office manager, billing coordinator, or outsourced billing team) should be working the aging report weekly, focusing on the 31+ day claims. As the practice owner, reviewing the aging distribution monthly is sufficient. You want to see the overall trend and catch any carrier-specific patterns.
What percentage of my AR should be over 90 days?
Less than 10% of total insurance AR. If more than 10% of your outstanding claims are over 90 days, your follow-up process needs attention. Above 20%, you’re almost certainly losing meaningful revenue.
Should I hire someone to manage insurance claims follow-up?
For practices producing over $1M annually, a dedicated insurance follow-up role (in-house or outsourced) typically pays for itself in recovered revenue. The math is simple: if your 90+ bucket has $30,000 in it and you recover even 50% of that with dedicated follow-up, that is $15,000 recovered, and a practice that generates new aged claims every month sees that benefit recur. An in-house insurance follow-up specialist typically costs $3,000 to $5,000 per month including benefits, while outsourced services run $1,000 to $2,500.
What’s the difference between the insurance aging report and accounts receivable?
In dental, they’re closely related but not identical. Your insurance aging report (from the PMS) shows outstanding insurance claims by age. Your accounts receivable in the accounting system is a broader number that can include patient balances, insurance claims, and other amounts owed to the practice. Your PMS aging report is the operational tool your billing team works from. Your accounting AR is the financial reporting number.
How does insurance aging connect to my P&L?
On a cash basis, it doesn’t show up directly. Cash basis records revenue when money is deposited, so outstanding claims are invisible in the P&L. This is one of the reasons cash basis financials can be misleading. On an accrual basis, or with production-based management reporting, outstanding claims appear as receivables and give you a complete picture of earned-but-uncollected revenue.
Related reading:
P.S. Reciprocity Accounting keeps your insurance aging and AR coded correctly so the report actually reflects what is collectible. See how we can help your practice.
