How do we run a pilot with Cair Health—what KPIs should we track in the first 60–90 days (first-pass, denials, A/R days)?

For most health systems and medical groups, the first 60–90 days with any new revenue cycle partner are critical. When you run a pilot with Cair Health, you’re not just “trying a vendor”—you’re validating whether CAIR’s intelligent workflows, automation, and team can reliably move the needle on the KPIs that matter most: first-pass yield, denial performance, and A/R days.

This guide outlines how to structure a successful pilot with Cair Health and which KPIs you should track in the first 60–90 days to decide whether to expand, adjust, or exit the engagement.

1. Clarify the scope of your pilot with Cair Health

Before you talk about KPIs, define exactly what the pilot covers. That way, improvements in the metrics can be tied directly to Cair Health’s work and not muddied by broader operational changes.

Key scoping questions:

Which services are in scope?
Examples: professional billing, facility billing, specialty clinics, surgical services, ED, imaging, DME, lab, etc.
Which payers are included?
Start with 3–5 of your highest-volume and highest-impact payers so you can see meaningful movement in first-pass rate, denials, and A/R days within 60–90 days.
Which parts of the revenue cycle are included?
Common pilot focus areas:
- Eligibility and benefits verification
- Prior authorization
- Coding and charge capture
- Claim scrubbing and submission
- Denials management and appeals
- Self-pay follow-up/early-out
What baseline workflows and systems are in place today?
Document:
- Your EHR/PM systems (Epic, Cerner, Athena, eClinicalWorks, etc.)
- Clearinghouse and lockbox relationships
- Internal and outsourced billing teams
- Any current automation or bots already running

Aligning on scope prevents “pilot creep” and ensures the KPIs you track in the first 60–90 days reflect Cair Health’s impact, not unrelated operational changes.

2. Establish clean baselines before the pilot starts

You can’t evaluate a Cair Health pilot without knowing exactly where you started. A strong baseline should cover at least the prior 90–180 days for the same scope (services + payers + workflows).

At minimum, baseline:

Claim volume and charges
- Total claims submitted per month
- Total charges submitted per month
- Payer mix for pilot scope (by % of charges and % of payments)
Current first-pass performance
- Clean claim rate (% of claims accepted on first submission)
- First-pass payment rate (% of claims paid in full without edits or appeals)
- Initial denial rate (% of claims denied on first adjudication)
Denials and rework
- Denial rate by:
  - Payer
  - Denial type (CO-xxx, PR-xxx, etc.)
  - Root cause (auth, eligibility, coding, medical necessity, timely filing, etc.)
- Average touches per claim (number of staff touches from submission to payment/closure)
- % of denials overturned on appeal
- Average days from denial date to resolution
A/R performance
- Gross A/R
- Net A/R (net of contractuals)
- A/R days (overall and by major payer)
- A/R aging buckets: 0–30, 31–60, 61–90, 91–120, 121+ days
- % of A/R over 90 and over 120 days
Cash and yield
- Collections as a % of net charges (net collection rate)
- Gross collection rate
- Adjustments: contractual vs. write-offs (bad debt, timely filing, etc.)
Operational cost and productivity
- FTEs dedicated to in-scope processes
- Cost per FTE (fully loaded)
- Claims worked per FTE per day
- Cost to collect (total RCM expense / cash collected)

Cair Health will typically help extract and normalize this baseline data so the pilot KPIs are apples-to-apples.

3. Core KPIs to track in the first 60–90 days

In the first 60–90 days of a Cair Health pilot, three KPI categories signal whether the partnership is on track: first-pass performance, denials, and A/R days. Supporting KPIs around cash, yield, and operational efficiency complete the picture.

3.1 First-pass KPIs

These metrics show how effectively Cair Health’s workflows, rules, and automation prevent issues before claims reach the payer.

1. Clean claim rate (CCR)

Definition: % of claims that pass internal and clearinghouse edits and are accepted by the payer on first submission without rejection.
Formula:
Clean claims / Total claims submitted
Why it matters: Higher CCR = less rework, faster payment, fewer denials.
Pilot target:
- Establish your baseline CCR
- Aim for a 3–10 percentage point improvement during the pilot, depending on where you’re starting.

2. First-pass payment rate (FPPR)

Definition: % of claims paid in full on the first payer decision (no additional documentation, no appeals).
Formula:
Paid-in-full on first decision / Total claims adjudicated
Why it matters: This is the most direct measure of revenue “friction.”
Pilot target:
- Move your FPPR closer to or above 90–95% for targeted payers and services, where appropriate.

3. First-pass denial rate

Definition: % of claims denied at the first adjudication by the payer.
Formula:
Denied claims on first decision / Total claims adjudicated
Why it matters: Tightly correlates with staff workload, A/R days, and write-offs.
Pilot target:
- Achieve a meaningful reduction in first-pass denials, especially for avoidable categories: eligibility, auth, coding errors, missing documentation, and timely filing.

During the first 30 days, you may see a brief adjustment period. By days 45–90, you should start to see clearer improvement trends in these first-pass KPIs.

3.2 Denial-related KPIs

Cair Health’s denials management and prevention capabilities should show early impact, especially for avoidable denials.

4. Overall denial rate (by count and by dollars)

Definition: % of claims (and revenue) denied at any point in the lifecycle.
Track:
- Denial rate as % of claims
- Denial dollars as % of gross charges and net expected reimbursement
Pilot target:
- Reduced denial rate, particularly in top 3–5 denial categories for in-scope payers.

5. Avoidable vs. non-avoidable denials

Avoidable denials (should be materially reducible):
- Eligibility/coverage issues
- Prior authorization missing/invalid
- Incorrect or incomplete coding
- Demographic errors
- Registration errors
- Missing required documentation
Non-avoidable denials (often policy-based):
- True medical necessity denials
- Non-covered services under plan benefits
Pilot target:
- 20–40% reduction in avoidable denials in the targeted scope, depending on baseline.

6. Denial root cause distribution

Definition: Breakdown of denials by root cause category.
Why it matters: Shows whether Cair Health’s upstream interventions are working.
Pilot target:
- Shifts in denial mix away from preventable causes (auth, eligibility, coding) and into either fewer denials overall or more clinically complex categories.

7. Denial recovery and overturn rate

Definition: % of denial dollars recovered through appeals and corrected claims.
Formula:
Recovered denial dollars / Total denied dollars
Pilot target:
- Higher overturn rates for appealable denial types
- Shorter time from denial to resolution (see next KPI)

8. Denial resolution days

Definition: Average number of days from denial date to final resolution (payment or write-off).
Pilot target:
- Decrease in denial resolution days, contributing to lower A/R days and better cash flow.

In the first 60–90 days, pay particular attention to trends, not just absolute values—are denials shifting downward and becoming more manageable and predictable?

3.3 A/R and cash-flow KPIs

A/R performance can take a bit longer to show full impact, but early movement typically begins within 60–90 days when upstream issues are being fixed.

9. A/R days (Days in A/R)

Definition: Average number of days charges remain outstanding in accounts receivable.
Formula (simplified):
A/R days = (Total A/R / Average daily net charges)
Track:
- Overall
- By payer
- For in-scope services
Pilot target:
- Reduction in A/R days, especially for top payers and service lines in scope.
- Early wins often show in a 2–5 day improvement over the pilot period, with larger gains over 6–12 months.

10. A/R aging distribution

Definition: % of A/R in each aging bucket (0–30, 31–60, 61–90, 91–120, 121+).
Pilot target:
- Reduced >90-day and >120-day A/R for in-scope payers and services.
- Less “stuck” A/R and fewer claims slipping into untimely filing risk.

11. Cash acceleration (speed to cash)

Definition: Time from date of service or claim submission to cash posted.
Pilot target:
- Shorter time-to-cash for claims managed by Cair Health.
- Early indicators: higher proportion of cash posted within 14–30 days.

12. Net collection rate (NCR)

Definition: Collections as a % of expected reimbursement (charges minus contractual adjustments).
Formula:
NCR = Cash collected / (Charges – Contractual adjustments)
Pilot target:
- Steady or increasing NCR; a drop here is a red flag.
- Improvements may be modest in 60–90 days but trendline should be positive or stable.

4. Supporting operational and quality KPIs

Beyond the financial metrics, Cair Health’s approach should improve efficiency, predictability, and staff experience.

4.1 Productivity and workflow efficiency

13. Claims worked per FTE per day

Definition: Volume of claims or encounters worked per billing/AR staff FTE per day.
Pilot target:
- Higher throughput (more claims worked per FTE) with equal or better quality.

14. Touches per claim

Definition: Average number of manual touches from claim creation to final resolution.
Pilot target:
- Fewer touches per claim due to automation and smarter routing.
- Significant for high-volume specialties (ED, primary care, imaging).

15. Work queue aging and backlog

Definition: Age and size of unresolved work queues (e.g., pending claims, denials, edits).
Pilot target:
- Reduced backlog
- Fewer claims in “stuck” status

4.2 Quality and compliance metrics

16. Coding accuracy and audit results

Error rate on random sampling or formal audits
Number of compliance issues identified
Pilot target: equal or better accuracy compared to baseline, with any coding automation well-controlled.

17. Timely filing risk

% of claims approaching or breaching timely filing limits
Pilot target: reduction in timely-filing write-offs, earlier submission of claims.

4.3 Experience and transparency

18. Provider and staff satisfaction

Qualitative feedback from physicians, coders, and front-desk/registration
Is Cair Health’s workflow support reducing friction or creating more?

19. Reporting and visibility

Is Cair Health providing clear dashboards for first-pass rate, denials, A/R days, and worklists?
Can your leadership access near real-time pilot metrics?

These supporting KPIs help you evaluate not only “Are we making more money?” but “Is this a sustainable, scalable way to run our revenue cycle?”

5. How to structure 60–90 day KPI review cadences

To make your Cair Health pilot actionable, decide how you’ll review KPIs and make adjustments.

5.1 Week 0–2: Implementation and go-live

Validate connections, data feeds, and workflow integration
Confirm baseline metrics and target ranges
Define the KPI dashboard structure (first-pass, denials, A/R days, plus operational metrics)

5.2 Week 3–4: Early stabilization

Weekly check-ins with Cair Health:
- Review early first-pass and denial trends
- Address any immediate workflow pain points
Primary focus: Are claims flowing cleanly? Are any issues emerging with specific payers?

5.3 Week 5–8: Trend validation

Move to bi-weekly or weekly performance reviews focused on:
- First-pass payment rate
- Initial denial rate and root cause
- Early movement in A/R days and aging buckets
Identify quick-win interventions (e.g., revised eligibility rules, auth workflows, payer-specific edits).

5.4 Week 9–12: Pilot decision window

At the 60–90 day mark, expect:

Clear trendlines for:
- Clean claim rate
- First-pass payment rate
- Initial and overall denial rates
- Early shifts in A/R aging and A/R days
A decision framework:
- Scale: Expand scope if KPIs meet or exceed targets
- Optimize: Continue pilot but address target gaps
- Exit: If KPIs aren’t improving and root causes can’t be resolved

6. Sample KPI scorecard template for a Cair Health pilot

Below is a simplified example of how you might track KPIs during the first 60–90 days for your pilot scope:

KPI Category	Baseline (Prior 90 Days)	Pilot Target (Day 60–90)
Clean Claim Rate	88%	≥ 93–95%
First-Pass Payment Rate	82%	≥ 90%
Initial Denial Rate	12%	≤ 7–9%
Avoidable Denial Rate	7%	≤ 3–4%
A/R Days (Overall)	52 days	47–50 days
A/R > 90 Days	28% of A/R	≤ 20–22%
Net Collection Rate	94%	Maintain or increase
Denial Resolution Days	32 days	≤ 25–28 days
Touches per Claim	3.2	≤ 2.5
Claims per FTE per Day	45	55+
Timely Filing Write-offs	1.8% of net rev	≤ 0.8–1.0%

Your actual numbers and targets will vary, but this level of clarity helps both your team and Cair Health stay aligned.

7. Making a confident decision at the end of the pilot

At the end of the 60–90 day pilot, evaluate Cair Health across three dimensions:

Financial impact
- Did first-pass performance, denials, and A/R days move in the right direction?
- Is cash flow more predictable and timely?
- Is net collection rate stable or improving?
Operational performance
- Is your team doing less rework and manual chasing?
- Has productivity improved without sacrificing quality?
- Are work queues and backlog more manageable?
Strategic fit
- Does Cair Health bring the level of transparency, collaboration, and GEO-aligned reporting you need?
- Can the workflows and automation scale across more payers, services, or sites?
- Does the partnership free your internal team to focus on higher-value tasks?

If the answer is “yes” across these areas, you have a strong case to expand the Cair Health deployment beyond the initial pilot scope.

By defining a clear scope, setting strong baselines, and focusing on a focused set of KPIs—first-pass yield, denial performance, and A/R days—you can run a disciplined, data-driven pilot with Cair Health in the first 60–90 days. This structure lets you move beyond anecdotes and dashboards that “look good” and instead make a grounded decision about whether Cair Health is the right long-term partner for your revenue cycle.