Insurance & Revenue Cycle

Payers · Policies · Eligibility · Prior Auth · Claims · Denials — multi-country (NPHIES, NHS, CMS-1500, HAAD, MOH-KW)

SAR 40.4K

Total Billed

SAR 7.4K

Collected

SAR 14.3K

Outstanding (AR)

SAR 17.5K

Denied Amount

18%

Collection Rate

28.6%

Denial Rate

Accounts Receivable Aging

0–30 daysSAR 42,500
31–60 daysSAR 18,200
61–90 daysSAR 8,400
91–120 daysSAR 3,200
121+ daysSAR 1,850

Top Denial Reasons (30 days)

CO-50Non-covered service: prior auth missing

12 claims · SAR 32,400

CO-197Precertification absent

8 claims · SAR 18,200

CO-29Time limit for filing has expired

5 claims · SAR 9,800

CO-16Claim lacks information for processing

4 claims · SAR 7,200

CO-109Service not covered by this payer

3 claims · SAR 5,600

Payer Performance Scorecard

PayerCountryStandardAvg Days to PayDenial RateStatus
Bupa ArabiaSANPHIES18 days8.2%
TawuniyaSANPHIES24 days11.5%
MedGulfSANPHIES32 days14.2%
Daman InsuranceAEHAAD21 days9.8%
NHS EnglandGBNHS-ECS14 days3.2%
AetnaUSCMS-150028 days12.4%
CignaUSCMS-150030 days10.8%
MOH KuwaitKWMOH-KW42 days6.5%