Payment statuses explained
A payment status describes a line item’s current payment/adjudication state. Payment statuses are used to:
Organize and filter worklists
Drive reporting on line item counts and dollars by status
Determine which lines that have issues are worth working and which can be ignored
Payment statuses are different from workflow statuses, though they both help you organize your work. You can think of the two like this...
Concept | Applies to | Purpose |
Payment status | Line item | Payer/practice adjudication state (e.g. Denied, Underpaid, Recovered, Written off) |
Workflow status | Claim (per worklist) | Where the claim is in your team’s process (e.g. Detected, Submitted to payer, Closed) |
Each line item has one payment status at a time.
Each claim has one workflow status per worklist at a time.
Use payment statuses to filter worklists, report dollars and counts, and decide what’s worth working. Use workflow statuses to track productivity and bucket work in your practice’s process.
View and configure your payment statuses
Navigate to Account settings, select the desired product page in the left bar (Denials, Underpayments, or Non-Response), and go to the Payment statuses tab.
You'll see a Payment statuses table that includes a list of out-of-the-box statuses, as well as the ability to configure and add to those statuses.
Worklist specific statuses (Recovered vs Paid, Retracted vs Denied)
Most payment statuses are global, meaning if a line item appears on multiple worklists, it should have the same payment status across all views. However, there are certain payment statuses that will only appear on a specific worklist and will show as something else on the All Claims list. These cases are called out in each product's payment status settings page, as well as below.
Retracted (Underpayments) vs Denied (Denials/All Claims) - same retraction, different label by worklist.
Recovered (Underpayments/Denials) vs Paid (All Claims) - recovery shown on issue worklists; All Claims uses Paid.
Show or hide statuses on the worklist
Use Show on worklist to hide payment statuses your team shouldn’t work (e.g. write-offs you'll never pursue). Hidden statuses will still exist for reporting and automations - they just won’t clutter your worklist.
Rivet-designated payment statuses can't be hidden. Any changes to the visibility of a status will apply to the account as a whole - it's not a user-specific setting.
To show or hide a payment status on the worklist, click Edit in the upper right of the Payment statuses table, then select the desired visibility for your statuses.
Add a new payment status
You can add as many custom payment statuses as needed. To do so, click Edit in the upper right of the Payment statuses table, click Add status, and then fill in the name, description, and color of your new status. Click Save status changes to apply your changes.
Edit an existing payment status
To edit the name, description, or color of any existing payment statuses, click Edit in the upper right of the Payment statuses table, complete your changes, and then click Save status changes.
Delete a payment status
Payment statuses can only be deleted if they are not involved in an existing automation. If they are being utilized in an automation, you'll see the ability to delete the status will be disabled with an explanation as to why. Simply change or delete the automation(s) that payment status is a part of and then return to delete the payment status.
If a payment status is not involved in an automation but has line items associated with it, you'll be asked to move those line items to another payment status before deleting the status. You can always opt to move the lines back to their Rivet designated payment statuses.
After selecting the new status, you'll be able to click Delete and move.
Reorder payment statuses
Use the drag and drop function next to each payment status in the Edit payment statuses modal to reorder them. Reordering statuses in settings controls the order in which they appear in filters, the automation builder, and the manual override menu on the claim view.
How payment status changes work
Payment status overrides
From the Denials, Underpayments, or Non-response worklists, you can manually change the payment status of any line belonging to the respective worklist. You can do so from the claim view or as a bulk action on the worklist.
When a line is in a Rivet-designated payment status (e.g. Denied or Underpaid), you can change it to any custom payment status (e.g. Written off or Rejected). When a line is in a custom payment status, you can change it back to the Rivet-designated payment status or any other custom payment status.
Rivet keeps your status updates unless the claim itself changes or an automation rule applies
When Rivet imports new claim data or refreshes a claim, it checks whether anything about that claim has actually changed since the last update.
If nothing has changed since you (or Rivet's automation) last updated the payment status, Rivet will keep your existing status as is.
If something has changed, Rivet will update the payment status to match the new information.
If you manually changed a line's payment status and it now fits an automation rule, that automation will run as normal.
Payment status automations
Payment status automations let you define rules that set a payment status. For example, you might have a procedure code that always gets denied but that you're never going to have your team appeal. In that case, you can build an automation to set any line with that procedure code to automatically move from a denied payment status to a custom-set payment status.
Automations can only be built to move lines from a Rivet-designated payment status to a custom payment status. Automations cannot move a line from one custom status to another custom status.
To build an automation:
Click Create an automation in the upper right corner of the Payment status automations table
Select your the payment status(es) you want to move from
Add filters using the same fields and operators as the line-item worklist
Set the resulting payment status (aka the payment status those lines should move to)
Choose which claims (by transaction date) to apply the automation to
Click Preview claims data (enabled once the rule is complete) to open a new tab with the filtered worklist to view the lines that would be affected should you save the automation
Variance threshold in Underpayments
Your practice may want to keep lines with variance amounts above or below a certain threshold from being considered underpaid or overpaid. For this use case, we have a specific area in Underpayments settings to set this threshold.
Rivet sets this threshold at ±$ 0.08. To edit that amount, go to Account settings, then navigate to Underpayments in the left bar, then scroll to the bottom of the Payment statuses tab. There you'll see a section titled Payment variance threshold.
Here, you can set a dollar amount that determines how smaller underpayments and overpayments are handled. Underpaid and overpaid line items with variances within this amount will be automatically moved to the "Written off variance" payment status.
If an underpaid line item is later paid and the remaining variance is $0 or within the threshold the line will be marked Recovered.
If an overpaid line is later settled and the remaining variance is $0 or within the threshold, the line will be marked Paid.
