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TestimonialsTransition exposure calculator
How much cash should you set aside between close and first clean claim?
After a transaction, providers can keep seeing patients before payers are ready to pay for those visits. Cash sits in held claims, and some claims can age past timely filing. Enter a few numbers to see the size of that gap, and how it is calculated.
Your transaction
Pre-filled with typical figures. Adjust them to match your organization.
Estimated transition exposure
Total across the whole enrollment gap, not per month.
How we calculate thisFive steps, run separately for each payer line, then added up
Five steps, run separately for each payer line (commercial, Medicare & federal, Medicaid & MCO), then added up.
Split your collections by payer type
Your monthly collections are divided by the payer mix you set. Dividing by 30.4 gives each line's revenue per day.
Daily revenue per line = monthly collections × payer share ÷ 30.4Give each line an enrollment gap
The gap is the number of days of care delivered before that payer can be billed. With a new Tax ID: commercial 90 days, Medicare & federal 75 days, Medicaid & MCO 150 days. If the existing Tax ID carries over, contracts stay in place and only provider adds and the change-of-ownership filing remain, so each gap is cut to 40%. An EMR or billing-system change adds 45 days to every line.
Compare the gap with the timely-filing window
Timely filing is how long after the date of service you have to submit a claim: commercial 90 days, Medicare 365 days, Medicaid & MCO 120 days. Days of gap inside the window can still be billed once enrollment is effective, so they are delayed. Days beyond it are at risk of write-off.
Cash delayed = daily revenue × (the smaller of gap and window)
At risk = daily revenue × (gap − window, if above zero)Add the effect of closed panels (if you said yes)
25% of commercial and Medicaid & MCO revenue is treated as out-of-network. That slice's delayed cash moves to at risk, plus another 90 days of its revenue.
Size the workload
Applications = providers × payers × locations. We compare that with a realistic pace of 30 applications per FTE per month, over a 6-month integration window.
Assumptions usedGap lengths, timely-filing windows and capacity figures behind the model
| Assumption | Value | What it means |
|---|---|---|
| Commercial gap (new Tax ID) | 90 days | Typical range 60–120 days; effective at contract or credentialing, limited backdating |
| Medicare & federal gap (new Tax ID) | 75 days | Typical range 60–90 days; change-of-ownership filing on the CMS-855 |
| Medicaid & MCO gap (new Tax ID) | 150 days | Typical range 120–180 days; state enrollment plus each MCO separately |
| Existing Tax ID carries over | 40% of the gaps above | Contracts survive; add providers and file the change of ownership |
| EMR / billing-system change | +45 days, every line | Clearinghouse plus EDI/ERA/EFT re-enrollment, assumed to run after payer enrollment |
| Timely filing, commercial | 90 days | From date of service; many plans allow 90–180 |
| Timely filing, Medicare | 365 days | 12-month window, so most Medicare gap is recoverable |
| Timely filing, Medicaid & MCO | 120 days | From date of service; varies by state and MCO |
| Closed-panel share | 25% of commercial + MCO | Treated as fully out-of-network, plus 90 more days at risk |
| Enrollment throughput | 30 applications / FTE / month | Includes follow-up and rework |
| Integration window | 6 months | Benchmark for the capacity comparison |
| Ongoing growth mode | 3 months × $25k | Each new provider loses about 3 months of billing while enrolling; 70% delayed, 30% at risk |
Attend our webinar
Enrollment 101 for Healthcare M&A: A Live Playbook for Payer Enrollment, Billing and Protecting Cash Flow Through the Deal
The calculator shows how much cash an enrollment transition can hold up. Our webinar walks through how to plan around it, from pre-close contract review to preempting enrollment denials.
- Ritu Bhatnagar, Founder & COO, Neolytix
- Chris Marchese, COO, Vybe Urgent Care
Please read the numbers as a guide, not a forecast. This model runs on Neolytix planning assumptions, which may be quite different from your organization's. Your real gap depends on your payers, states, deal terms and how your team runs enrollment. Use it to understand the idea: how much cash to set aside, and why.
Ranges are directional and deliberately conservative. Payer, state and contract rules vary, and timely-filing limits for Medicaid and commercial plans differ by state and contract. Check them for each location. This is a planning tool, not legal or financial advice.
