Money owed to a provider for services already delivered but not yet paid. The pool the revenue cycle works to collect.

Any change to a claim's billed amount, whether a contractual discount or an administrative correction. Not the same as a payment.

How long a claim has gone unpaid, usually grouped into buckets: 0 to 30, 31 to 60, 61 to 90, and over 90 days. Older AR is harder to collect.

The work of chasing unpaid or stalled claims: checking status, resubmitting, appealing, and escalating until they resolve.

A formal request asking a payer to overturn a denied or underpaid claim, backed by documentation.

Balances written off as uncollectible after collection efforts are exhausted.

The standardized code on a remittance that explains why a payer adjusted or denied a line item.

Recording every billable service a patient received so it can be claimed. Missed charges are lost revenue.

A provider's master list of billable items and their prices.

The itemized bill a provider sends a payer for services rendered. Electronically, this is the 837 transaction.

Where a submitted claim stands with the payer: received, in process, paid, denied, or pending.

A claim with no errors or missing information, so it can be paid on the first submission.

The share of claims that go out error-free the first time. Rework is expensive, so higher is better.

A middleman that checks, formats, and routes claims between providers and payers.

The percentage of a covered cost a patient pays after meeting their deductible.

The gap between a provider's billed charge and the rate it agreed to accept from a payer. Written off, not collected.

The rules that decide which payer pays first when a patient has more than one insurance.

A fixed amount a patient pays for a covered service at the time of care.

What it costs a provider to collect each dollar of revenue, across staff, software, and outsourcing. A core efficiency metric.

The standardized code identifying a medical procedure or service for billing.

The average number of days it takes to collect payment after a service. Lower means cash arrives faster.

What a patient pays out of pocket before insurance starts covering costs.

A payer's refusal to pay a claim, in whole or in part. Some are final; many are winnable on appeal.

The share of claims a payer denies. A leading indicator of revenue leakage.

Earnings before interest, taxes, depreciation, and amortization, a common measure of operating profit. Money the revenue cycle recovers and cost it removes both flow straight to EBITDA, which is why finance leaders track it.

The standardized electronic format providers and payers use to exchange claims, remittances, and eligibility data.

The electronic health or medical record system where clinical and often billing data lives.

Confirming a patient's active coverage and benefits before care, so claims aren't denied later.

The statement a payer sends explaining what it paid, adjusted, or denied, and why.

The electronic remittance: how a payer tells a provider what it paid and adjusted, used to post payments.

The share of claims paid on the first submission with no rework. The cleanest, cheapest way to get paid.

Total payments divided by total charges. A rough measure, less meaningful than net collection rate because charges are inflated.

Codes for products, supplies, and services not covered by CPT, such as durable medical equipment.

A workflow where a person reviews or approves what an automated system does. Lower autonomy keeps a human in the loop for routine work; higher autonomy does not.

The standardized diagnosis codes that justify the medical necessity of billed services.

Whether a service was appropriate and required for the patient's condition. A common reason payers deny or claw back payment.

A code added to a procedure to give the payer more detail, such as which side of the body or a special circumstance.

The share of collectible revenue a provider actually collects, after contractual adjustments. The clearest single measure of revenue cycle performance.

The revenue a provider expects to keep after contractual adjustments and discounts. The base for most revenue cycle math.

The portion of a bill the patient owes: copay, coinsurance, deductible, and non-covered charges.

The insurance organization responsible for paying a claim, such as a commercial plan, Medicare, or Medicaid.

The web system a payer provides for checking eligibility and claim status and submitting documentation. Often the only way to get certain information.

Recording payer and patient payments against the right claims, including adjustments and denials, so AR stays accurate.

The software that handles scheduling, billing, and claims for a practice.

A payer's advance approval required before certain services, or the claim is denied. Often called prior auth or PA.

A code that adds detail to a CARC, further explaining a payer's adjustment or denial.

When a payer takes back money it already paid, usually by offsetting future payments. Also called a takeback.

A payer's request for more records before it will process a claim. Unanswered RFIs stall revenue.

Software bots that repeat scripted, rule-based steps. Fast for stable tasks, but they break when portals or rules change.

A claim that flows from submission to payment with no manual touch.

An itemized form listing the services a patient received, used to generate a claim.

The deadline by which a claim must reach the payer. Miss it and the claim is denied with little recourse.

When a payer pays less than the contracted rate. Often missed because the claim shows as paid, not denied.

The prioritized list of claims or tasks staff work through, such as denials to appeal or claims to follow up.

Revenue a provider decides not to pursue, whether a contractual adjustment or an uncollectible balance.

A revenue cycle where AI agents run their defined scope end-to-end and escalate only true exceptions, rather than software that speeds up single tasks. The category Substrate ARC defines.

Software that carries out a multi-step workflow on its own, adapting to what it finds, instead of following a fixed script.