How to run a one-batch claim-follow-up pilot

September 4, 2026

A claim-follow-up pilot should answer a buying question: can this partner return work your team can use, at an effort and cost that make sense?

That sounds straightforward until the batch comes back. Some claims have a clear answer. Some are waiting. Some need information from your team. A report says the work is complete, but your lead still has to reconstruct what happened before deciding what to do.

The problem is not necessarily the work. It may be that nobody agreed what the pilot was supposed to prove.

A one-batch pilot is useful because its boundaries can be explicit. You can inspect the inputs, the results, and the work that remains. Here is a practical way to design one.

Choose one question the pilot can answer

“Reduce AR” is a business objective. It is too broad to be the only test of a short claim-status engagement.

A more useful pilot question might be: can the partner establish why a defined group of pending claims is stalled and return findings that our team can act on without repeating the inquiry?

That question gives the review a shape. It requires a defined population, an agreed inquiry, supporting information, and a next step. It does not pretend that every answer will produce an immediate payment.

Write the question down before selecting the batch. If the first result would not help answer it, reconsider the scope.

Select a batch that resembles the work you would actually send

A collection of unusually easy claims can make a weak process look good. A collection of exceptional cases can make a useful process look unsuitable for ordinary work.

Start with a clearly defined group: the relevant practice or practices, payer mix, claim status, age range, and information available. Include a realistic mix within that group. Keep unusually difficult exceptions visible rather than quietly removing them after work begins.

If you choose a narrow segment, that is fine. Just keep the conclusion equally narrow. A successful pilot on one type of inquiry is evidence about that inquiry, not about every payer or every part of the revenue cycle.

There is no universal batch size that proves a service works. Pick a batch large enough to expose variation and small enough for your team to review meaningfully. Agree the size with the partner based on scope and review capacity.

Record the starting point

For each case, preserve the information needed to understand what changed: the question, last known status and its date, prior work, known blockers, and any verified deadlines relevant to the inquiry.

Also record the time your team spends preparing and clarifying the batch. Intake is part of the pilot's cost, not background effort to leave out of the evaluation.

If you compare the pilot with internally worked claims, make the groups reasonably comparable and use the same observation period. A comparison between different payer mixes or different stages of aging can mislead. A small pilot can support a practical decision without proving that the vendor caused every difference you observe.

Define “usable” before defining “complete”

A completed follow-up task is not necessarily a paid claim. Agree which results count as useful for the selected inquiry.

For example, a verified request for additional information can be useful if it identifies what is needed and who owns the response. A confirmed pending status can be useful if the source, timing, and appropriate next step are documented. An unexplained “still pending” may not meet the same standard.

Agree how to report cases that cannot be worked, cases missing information, and cases requiring action outside the scope. They should remain visible in the batch reconciliation, even if they are excluded from a particular performance measure.

Use a scorecard that includes your team's effort

The following is a proposed evaluation framework, not an industry benchmark or a claim about Halcora's performance.

Measure	What to record
Batch reconciliation	Submitted, accepted, returned, still open, and excluded cases, with reasons.
Usable-result rate	Results meeting the agreed acceptance criteria divided by accepted cases due for return in the review window. Report cases not yet due separately.
Supporting information	Whether each reviewed finding has a source or basis, a relevant date, and enough context to evaluate it.
Rework	Results needing correction or clarification, including how much review time they consumed.
Turnaround	Time from agreed intake acceptance to result delivery; distinguish work time from waiting on missing information.
Internal effort	Time spent preparing the batch, answering questions, reviewing results, and carrying out retained responsibilities.
Remaining actions	What still needs doing, who owns it, and whether it is included in the engagement.
Financial movement	Payments or adjustments observed during the agreed window, reported separately from completed inquiries.

Keep the definitions stable. If a denominator changes, show why. Count an amended result as a correction to the original case, not as a second successful result.

Review a sample deeply, not just the summary

Read returned records alongside the supplied history. Can your lead understand what was established? Is uncertainty visible? Could another person take the next action without rebuilding the case?

Look at ordinary results, exceptions, and corrections. Ask about a case that did not go well. How the partner explains and fixes it may be more informative than its cleanest example.

Separate money collected from money attributable to the pilot. A payment received during the review window may reflect earlier work or normal processing. Record the movement without automatically assigning all the credit to the most recent touch.

Decide what the evidence supports

There are three reasonable decisions: expand the same workflow, refine the scope and test again, or stop.

Before choosing, complete this short review:

Did the returned work answer the original pilot question?
Were the findings sufficiently documented to use?
What preparation, supervision, and rework did our team provide?
Which exceptions limit what we can conclude?
Are the price and remaining responsibilities clear?
What would have to stay the same for the next batch to work?

A good pilot does not require a perfect batch. It requires a result that is clear enough to support the next decision.

Considering a first batch? Talk with Halcora about the workflow. Describe the backlog in general terms; do not include patient information in the inquiry.