ASC Alpha / A/R follow-up specialist / Specialty Packs
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A/R follow-up specialist

Which balances can I recover or escalate?

Next-best action: Outreach to BCBS clearinghouse regarding claim CLM-201 outstanding for 145 days.
A/R Outstanding
$845,000
A/R > 120 Days
28 accounts
Recovery Rate
94.2%

Specialty Configuration Packs

Citron Specialty Packs configure the operational guardrails, documentation requirements, and payer memory logic to match the clinical nuances of each specialty.

Anesthesia (anesthesia)

Care Settings
  • Ambulatory Surgical Center
  • Operating Room
KPI Baseline Targets
Clean Claim Rate: 94.0%
Days In Ar: 34
Denial Rate: 3.5%
Recovery Margin: 12.0%
Common Denial Categories
Medical Necessity for MAC vs GeneralConcurrent Care Limits ExceededUnauthorized Adjunctive Services
Documentation Gaps
  • Anesthesia start/stop times missing or inconsistent
  • Lack of documented patient physical status evaluation notes
Payer Evidence Requests
  • Pre-anesthesia evaluation checklist
  • Intraoperative anesthesia record detailing time logs
Sample Next-Best Actions
  • Audit concurrency records for CRNA medical direction claims
  • Appeal MAC anesthesia denial with documented patient comorbidities

GI / endoscopy (gi_endoscopy)

Care Settings
  • Ambulatory Surgical Center
  • Endoscopy Suite
KPI Baseline Targets
Clean Claim Rate: 95.5%
Days In Ar: 32
Denial Rate: 3.0%
Recovery Margin: 14.2%
Common Denial Categories
Routine Screening ConversionFrequency Limits ExceededMedical Necessity for Multiple Endoscopies
Documentation Gaps
  • Lack of pathology report for polypectomy confirmation
  • Missing surveillance interval history
Payer Evidence Requests
  • Referring provider screening orders
  • Pathology and biopsy reports
Sample Next-Best Actions
  • Appeal diagnostic colonoscopy conversion with preventive modifier 33
  • Match pathology report to verify biopsy charge codes

Interventional radiology (interventional_radiology)

Care Settings
  • Ambulatory Surgical Center
  • Vascular Lab
KPI Baseline Targets
Clean Claim Rate: 88.0%
Days In Ar: 45
Denial Rate: 6.2%
Recovery Margin: 25.0%
Common Denial Categories
Unbundled Component CodesMedical Necessity for Multi-Vessel AngioplastyAuthorization for Changed/Expanded Procedures
Documentation Gaps
  • Missing angiography/venography imaging prints
  • Lack of pre-operative ABI (Ankle-Brachial Index) documentation
Payer Evidence Requests
  • Vessel-level imaging report summaries
  • Clinical notes outlining conservative wound care trials
Sample Next-Best Actions
  • Review catheterization codes hierarchy for atherectomy claims
  • Submit ABI and vascular maps to support multi-vessel auth mismatch

Orthopedic ASC (ortho_asc)

Care Settings
  • Ambulatory Surgical Center
  • Outpatient Department
KPI Baseline Targets
Clean Claim Rate: 92.0%
Days In Ar: 38
Denial Rate: 4.5%
Recovery Margin: 18.5%
Common Denial Categories
Experimental/InvestigationalMedical Necessity LackAuthorization Mismatch
Documentation Gaps
  • Missing conservative therapy trials
  • Lack of surgeon op note detailing meniscectomy margins
Payer Evidence Requests
  • Physical therapy history logs
  • X-ray/MRI reports confirming joint narrowing
Sample Next-Best Actions
  • Draft orthopedic appeal for CPT 29881 with conservative therapy logs
  • Reconcile implant invoices for arthroplasty charge validation

Pain and spine (pain_spine)

Care Settings
  • Ambulatory Surgical Center
  • Procedure Suite
KPI Baseline Targets
Clean Claim Rate: 89.0%
Days In Ar: 44
Denial Rate: 6.0%
Recovery Margin: 20.5%
Common Denial Categories
Experimental Treatment for SCS/Pain PumpsFrequency Limitations on Facet InjectionsLack of Step Therapy Documentation
Documentation Gaps
  • Missing visual analog scale (VAS) pain score history
  • Lack of pre-service psychological clearance report for SCS implant
Payer Evidence Requests
  • Consecutive clinical notes showing pain scale improvement
  • Step therapy records showing failed physical therapy and oral meds
Sample Next-Best Actions
  • Match diagnostic injection response notes to verify facet injection criteria
  • Appeal spinal cord stimulator lead denial with trial success logs

Retina / ophthalmology (retina_ophthalmology)

Care Settings
  • Ambulatory Surgical Center
  • Ophthalmic Clinic
KPI Baseline Targets
Clean Claim Rate: 90.0%
Days In Ar: 42
Denial Rate: 5.5%
Recovery Margin: 22.0%
Common Denial Categories
High-Cost Specialty Drug Policy LackBilateral Procedure Overpayment/UnderpaymentFrequency Limitations on Injections
Documentation Gaps
  • Visual acuity measurements missing in pre-op notes
  • Optical Coherence Tomography (OCT) scans not attached
Payer Evidence Requests
  • Pre-injection OCT imaging reports
  • Specialty drug invoice and dosage logs
Sample Next-Best Actions
  • Appeal intravitreal drug denial with OCT imaging evidence
  • Verify CPT laterality modifiers for bilateral cataract claims