The Purpose of Payer Mapping
Mapping your payers serves as a bridge between the payer names within the Rivet platform with the payer names within your practice management system. When patient demographic data is imported to Rivet from your practice management system, it is imported with the payer identifiers that exist in your practice management system. These identifiers are unique to each practice and widely vary in spelling and naming conventions. That is why we use payer mapping to manually assign Rivet-recognized payer names to how payer names appear in your PM system.
Payer mapping also enables patient benefit information to appear in Rivet. Mapping payers means that a connection will be established, allowing Rivet to pull eligibility information for specific patients.
This article will explain how to map payers, and what to do if eligibility errors occur.
How to Map Payers
Click on your account name in the top right corner of Rivet, and then Account. Then go to the Insurance Product Crosswalk on the left-hand side of the page.
The insurance products come from patient records and/or claims. For payer mapping, it will be easiest to begin by sorting the list by the number of patients. Click on the “# of Patients” header to sort by the highest number of patients.
Next, you can do one of two things:
Map all payers in the order of highest number of patients to lowest
Search for one payer at a time, searching only for the relevant payers
Only one of these options is required. Which option you choose to do will depend on the situation. If you are attempting to map all claims or patients to a fee schedule, then proceed with the first option. If you want to focus on one payer at a time, choose the second option.
The following steps will show you how to do the second option by searching for a specific payer at a time. However, the steps will be very similar if doing the first option, except that you won’t need to search for a payer at the beginning.
Type the payer's name in the search bar. For example, search “united” for United Healthcare. Select all insurance products that apply to United Healthcare.
Next, click the Eligibility payer dropdown. Here is where you will map the insurance products to Rivet’s payers. Search again for the payer, and select the most applicable.
Note: If a payer seems to appear both under "My Payers" and "All Payers," you'll want to select the one under "My Payers," because that is the payer that you have used to build fee schedules in this account.
The Claims Payer dropdown will allow you later to map an insurance product to a specific fee schedule. Select the appropriate payer for this dropdown as well.
Once the payers have been mapped (they should now appear in the dropdowns within the table), you can clear your selection. Then you can search for other payers that you wish to map.
One important thing to note is the Trading Partner column. This column is how you can know that the mapped payer will return the correct benefits. If, after mapping the eligibility payer, there is no trading partner name, then that means that the Rivet payer you selected doesn’t have an EDI connection with Availity, the third party that Rivet uses for eligibility checks. If that is the case, you will need to either find another payer that does have a trading partner, or you will need to always call the payer for eligibility information for those patients.
For further assistance, feel free to contact our support team via chat or email at support@rivethealth.com.
Suggested next article: Insurance Product Crosswalk