Within the Rivet application underpayment, variances are categorized by a specific “status” to help the user both sort the variances by status and also understand its current stage and potential next step.
To see variances within a specific status click the “Set status” and select the stage for viewing. The variances within that status will be filtered and shown.
To view the different statuses of an Underpayment follow these steps:
Select the claim you’d like to change the status of
Click on actions
Select ‘Set Status’
Choose from the different statuses
Now let’s talk about the statuses - Each status has a specific definition which is reflected below.
Detected | Any new claim line that has been underpaid or overpaid that has not yet been categorized is automatically assigned “detected” by Rivet until recategorized. |
Sent | The project or claim(s) has been sent to the provider representative |
Reviewed | Denotes that the claim has been reviewed and is in the validation process to assess whether or not it is a valid underpayment |
Rejected | Payment variances that will not be worked. For example, claims that are past the timely filing limits or known, validated variance issues may be categorized with a “rejected” status. When “rejected” these claims will not be reflected in the underpayment variance table |
Invalid | Claims where the payer’s allowed amount is correct and is therefore an “invalid” variance. In this situation, your Rivet data needs to be updated to reflect the corrected, expected amount. Actions taken may include, but are not limited to; Updating a fee schedule, updating negotiated modifiers that are different than the “normal” reduction, or revisions to MPPR issues.) |
Retracted | A retracted claim refers to a previously submitted claim for reimbursement that has been withdrawn or canceled by the healthcare provider. This means that the claim is no longer considered for payment, often due to errors, corrections, or the submission of a revised claim. |
Recovered | Claims that have been reprocessed and paid correctly or a lump sum settlement has been given |
Resolved | Claims that has been fully addressed and settled, meaning any discrepancies in payment have been corrected, and the provider has received the appropriate reimbursement. This resolution can involve adjustments, appeals, or corrections to the initially underpaid amount. |
If you have any additional questions about Procedure Code Comparison, feel free to chat in or email at support@rivethealth.com.
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