Workflow statuses explained
A workflow status describes a claim's current state in the context of your practice's process. They will only ever appear on workflow-specific worklists like Denials, Non-Response, and Underpayments. They will not appear on the All Claims worklist because a claim could have multiple different workflow statuses depending on the issues it contains.
Use workflow statuses to...
Organize and filter worklists
Determine which claims need further action
Track productivity
Workflow statuses are different from payment 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 workflow statuses to track productivity and bucket work in your practice’s process. Use payment statuses to filter worklists, report dollars and counts, and decide what’s worth working.
View and configure your workflow statuses
Navigate to Account settings, select the desired product page in the left bar (Denials, Underpayments, or Non-Response), and go to the Workflow statuses tab.
You'll see a Workflow statuses table that includes a list of out-of-the-box statuses, as well as the ability to configure and add to those statuses.
Add a new workflow status
You can add as many custom workflow statuses as needed. To do so, click Edit in the upper right of the Workflow 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 Workflow statuses table, complete your changes, and then click Save status changes.
Delete a workflow status
Workflow 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 workflow status is a part of and then return to delete the status.
If a workflow status is not involved in an automation but has claims associated with it, you'll be asked to move those claims to another workflow status before deleting it. After selecting the new status, you'll be able to click Delete and move.
Reorder workflow statuses
Use the drag and drop function next to each workflow 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 status menu on the claim view.
How workflow status changes work
Change a status manually or through a bulk action
From the Denials, Underpayments, or Non-response worklists, you can manually change the workflow status of any claim belonging to the respective worklist. You can do so from the claim view, the worklist itself, or as a bulk action on the worklist.
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 workflow status, Rivet will keep your existing status as is.
If something has changed, Rivet will update the workflow status to match the new information.
If you manually changed a claim's workflow status and it now fits an automation rule, that automation will run as normal.
Workflow status automations
Workflow status automations let you define rules that set a workflow status. For example, you might want your team to send medical notes on appeals for all medical necessity category denials. In that case, you can build an automation to set any claim with that adjustment code category to automatically move from a Detected workflow status to a custom-set workflow status.
To build an automation:
Click Create an automation in the upper right corner of the Workflow status automations table
Add filters using the same fields and operators from the respective claim-level worklist
Set the resulting workflow status (aka the workflow 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 claims that would be affected should you save the automation
