This glossary provides definitions for all field names and data elements used in Rivet's claims worklists. Use this as a reference to understand what each field represents and how it's defined.
You may only see a subset of these fields depending on the products you have purchased.
A
Adjudication window
Average days between claim submission date and remit date, per payer. Shows custom value if set.Adjusted
The sum of CO, OA, CR, and PI adjustment code amounts. Does not include PR code amounts.Adjustment reason category
The category that the adjustment reason code (CARC) maps to.Adjustment reason code
The Claim Adjustment Reason Code (CARC).Allowed
The agreed-upon total payment for the service, including payer portion and patient responsibility.Allowed per unit
The agreed-upon total payment for the service, including payer portion and patient responsibility, divided by the number of units.Assignee
The Rivet user assigned to this claim.Athena status
The status of claims in Athena imported into Rivet through the Athena integration. Only available if you have an Athena integration and have purchased Claim Resolution.
B
Bill date
The date the claim was submitted to the payer. In cases where there are corrected claims, we show the date for the most recent claim transaction.Bill type
The three digit code on institutional claims indicating type of facility, type of care, and the billing frequency.Billing credential
The credential of the billing provider.Billing NPI
The National Provider Identifier of the billing provider.Billing provider
The name of the billing provider.Billing provider address
The address of the billing provider.Business unit
A Rivet organizational structure based on a unique combination of tax ID and facility type (ASC, Hospital, Professional).
C
Charged
The amount billed on the line item or claim.Claim adjustment code
The Claim Adjustment Reason Code (CARC) at the claim-level in the remit.Claim charge
The sum of the amounts billed on all line items on a claim.Claim count
The number of 837 files associated with the claim.Claim status category
The category that the status code maps to.Claim status code
The code on the 276/277 file that indicates the status of the submitted claim.Class of contract
The health insurance plan name returned on the remit by the payer.Coordination of benefits
Whether the payer is primary, secondary, or tertiary.
D
Date [issue]
The date of the remit that caused this line to be denied or underpaid.Date detected
The date the underpayment was detected by the Rivet system, either due to a remit or fee schedule or mapping update.Date of service (from)
The start date of the service period in which the patient saw the provider.Date of service (to)
The end date of the service period in which the patient saw the provider. In cases where there is only a single date of service, the Date of service (to) is copied from the Date of service (from).Date recovered
The latest remit date on which the denial or underpayment was recovered.Days since denial
The number of days that have passed since the date of the remit denying the claim.Days since DOS
The number of days that have passed since the date the patient saw the provider.Days to adjudicate
The number of days between the latest check date and date of service.Days to bill
The number of days between the bill date and date of service.Diagnosis code
The ICD10 codes indicating the diagnosis on the claim or line item.DRG code
The Diagnosis Related Group code used to group inpatient hospital stays.
E
EAPG code
The Enhanced Ambulatory Patient Group code used to group services in an outpatient visit.Expected allowed
The Rivet-calculated allowed amount based on the fee schedule mapped to this claim.Expected per unit
The Rivet-calculated allowed amount based on the fee schedule mapped to this claim divided by the number of units.
F
Fee schedule
The set of reimbursement rules mapped to this claim.
H
Has fee schedule override
Indicator of whether the claim has been manually overridden to map to another fee schedule.
I
Insurance product
A Rivet identifier based on a distinct combination of payer, insurance plan description, and insurance plan type.Is in project
Indicator of whether this underpayment is included in a suggested, draft, or sent project.Is past adjudication window
Indicator of whether a billed claim is past the expected adjudication window.
L
Last updated
The date of the most recent user or system action on the claim (e.g. comment, workflow status change, assignment).Last updated by
The user or system that made the latest update to the issue.Latest check #
The identifier of the latest check that was issued.Latest check date
The date the latest check (aka remit) was issued.Latest comment
The most recent comment left on a claim.Latest import date
The date Rivet imported the latest remit or claim file.Latest transaction
The date of the latest remit or claim file.
M
Medical record #
The unique identifier assigned to a patient in the EHR or PM system.Modifier
The two digit code that adds information to the procedure code.
N
NDC
The National Drug Code is a universal number assigned to each drug marketed in the United States.
O
Ordering NPI
The National Provider Identifier of the ordering provider.Ordering provider
The name of the provider who requested the services being billed.
P
Patient account #
The claim number associated with a patient visit.Patient address
The address of the patient on the claim.Patient age
The age of the patient on the claim at the time of the visit.Patient date of birth
The date of birth of the patient on the claim.Patient gender
The gender of the patient. If not specified on the 837 (when patient = subscriber), Rivet copies the subscriber's gender to the patient.Patient name
The name of the patient on the claim.Patient responsibility
The portion of the allowed amount the patient is responsible for paying, calculated as a sum of PR adjustment code amounts.Patient responsibility %
Patient responsibility divided by Allowed.Payee name
The legal name of the entity or individual that is receiving payment.Payer (claim)
The name of the payer on the claim file.Payer (mapped)
The Rivet system payer that the claim has been mapped to.Payer (remit)
The name of the payer on the remit file.Payer claim #
The payer-defined claim identifier that comes on the remit. May also be recognized as ICN or DCN.Payer denied
Dollar amount denied on line item or claim.Payer paid
The portion of the allowed amount that the payer paid.Payer paid %
Payer paid divided by Allowed.Payment status
Claims: The current state of the line item payment (billed, underpaid, denied, paid, custom, rejected).
Underpayments: The current state of the line item payment (underpaid, retracted, recovered, rejected).
Denials: The current state of the line item payment (denied, paid, custom).Place of service
The two digit code that indicates where the patient saw the provider.Prior authorization #
The number indicating the payer approved the treatment.Procedure code
The CPT or HCPCS code indicating the procedure.Procedure code group
The AAPC category the procedure code maps to (up to 3 levels deep).Provider taxonomy
The specialty of the rendering provider. This comes from the NPPES registry or overridden by values in the provider table.
R
Recode
Indicator of whether the payer returned a different code and modifier combination than was originally billed.Recovered (all)
The total dollar amount recovered from the payer that was previously denied, underpaid, or corrected.Recovered (denial)
The total dollar amount recovered from the payer that was previously denied.Recovered (variance)
The total dollar amount recovered from the payer that was previously underpaid.Referring NPI
The National Provider Identifier of the referring provider.Referring provider
The name of the provider who referred the patient for the services being billed.Remark code
The Remit Advice Remark Code (RARC).Reminder
The comment associated with the soonest upcoming or most recent past reminder set on this claim.Reminder date
The date associated with the soonest upcoming or most recent past reminder set on this claim.Remit count
The number of 835 transaction files associated with the claim.Rendering credential
The credential of the rendering provider.Rendering NPI
The National Provider Identifier of the rendering provider.Rendering provider
The name of the rendering provider.Revenue code
The 3-digit code that indicates the department or location a service was provided.RVUs (malpractice)
The Relative Value Units for the cost of professional liability insurance based on the estimated risk associated with each CPT code.RVUs (practice expense)
The Relative Value Units for the cost of clinical and nonclinical labor and expenses of the practice.RVUs (total)
The total Relative Value Units across work RVUs, practice expense RVUs, and malpractice RVUs.RVUs (work)
The Relative Value Units for the provider's work when performing a procedure or service. Calculated by multiplying the frequency associated with each CPT code billed during the period of time by the wRVU for each CPT code.
S
Sequestration
CO-253 adjustments accounting for the portion of Medicare reimbursements withheld by the government.Service facility address
The physical address of the facility where the service was performed.Service facility name
The name of the facility where the service was performed.Service facility state
The state of the facility where the service was performed.Service locality
The CMS locality where the service was performed, based on a mapping from zip code to locality.Subscriber address
The address of the person subscribed to the insurance plan.Subscriber date of birth
The date of birth of the person subscribed to the insurance plan.Subscriber gender
The gender of the subscriber.Subscriber group
The group name found on the subscriber ID card.Subscriber group #
The group number found on the subscriber ID card.Subscriber ID
The identifier found on the subscriber ID card.Subscriber name
The name of the person subscribed to the insurance plan.Supervising credential
The credential of the supervising provider.Supervising NPI
The National Provider Identifier of the supervising provider.Supervising provider
The name of the supervising provider.
T
Tax ID
The Tax ID associated with the claim.TIC expected allowed
The rate from the Transparency in Coverage data.Transaction date
The date the claim or remit transaction was issued.Transaction type
Whether something is a claim or remit file.
U
Units
The number of units associated with the procedure code.
V
Variance
The difference between the Rivet-calculated expected allowed and the actual allowed amount (Expected allowed - actual allowed).Variance %
The percent difference between the Rivet-calculated expected allowed and the actual allowed amount.
W
Workflow status
The status of the claim in the workflow.