Operational cost from repeated claim corrections and resubmissions

$10,000–$25,000/year in avoidable labor for 0.25–0.5 FTE focused on correcting CDT issues, adding missing attachments, and resubmitting PPO/HMO claims, plus delayed reimbursement and occasional write‑offs when claims time out. • $10,000–$25,000/year in dedicated insurance coordinator time consumed by avoidable rework instead of clean first‑pass submissions, directly matching the 0.25–0.5 FTE baseline. • $10,000–$25,000/year in front office management time plus overtime or added headcount, as they spend a significant slice of their week on claim cleanup instead of practice growth and patient service.

Assistants maintain separate Medicaid‑only checklists on paper or shared spreadsheets, double‑check radiographs and perio charting manually, and rely on trial‑and‑error plus feedback from denials to refine how they package claims. • Billers consult state Medicaid manuals and printed binders, track denied PA and treatment claims in spreadsheets, reassemble documentation from imaging and charting systems, and call Medicaid help lines to understand what to fix before resubmitting. • Billing staff maintain separate Medicaid cheat sheets and binders with state‑specific rules, manually cross‑check every Medicaid claim, and track denials and rework in Excel logs and paper folders, re‑faxing or uploading corrected claims with added attachments.