What is a non-response claim?
A non-response claim is a claim that you have billed out to a payer but haven't received a remit response from that payer. With the non-response workflow in Rivet, you can identify and take action on these claims to ensure all of your billed claims get adjudicated by your payers and well within your timely filing windows.
View all of your non-response claims by clicking on Non-Response from the Payers dropdown.
Claim status checks and how to use them
Claim status checks are a way Rivet can programmatically check the status of a claim that has not been responded to yet by the payer. The information returned through a claim status check explain the status of an outstanding claim, much like adjustment codes and remark codes explain why a claim may have been denied.
Payer responses to claim status checks contain two pieces of information:
Claim status codes: These codes convey the status of an entire claim or a specific service line
Claim category codes: These codes organize the Claim Status Codes (ECL 508) into logical groupings
Manually send a claim status check
You can manually send a claim status check by clicking into a claim in the Non-Response worklist and then clicking the purple Submit claim status check button in the right hand bar of the claim detail view.
Automate your claim status checks
In the Non-Response settings, you can set up automatic claim status checks for overdue claims (claims that have exceeded the expected payment window). This helps with early detection of issues in outstanding claims, ensuring timely payments.
When enabled, Rivet will automatically submit a status check for any claim past its expected payment window.
Note: Rivet uses Availity to power automated claim status checks. When Availity does not support sending claim status checks to specific payer, you will see the message “Claim status checks are not available for this payer." To view a full list of supported payers, click on this link and select “Real Time (SOAP)” and “Claim Status” in the filters on the right.
When a claim status checks response says “Clearinghouse error," this is typically because the information in the 837 claim (e.g. subscriber ID) was in a different format than what Availity uses. If this happens often, please reach out to our support team.
Steps
Navigate to your account settings
2. Click on Non-Response on the left hand side, then click on the Claim status checks tab.
4. Enable the automatic claim status check toggle
Monitor your usage
The Usage module shows you how many claim status checks you have left in your account. Each account is provided 5% of its claim volume’s worth of claim status checks for free. Your account administrator will receive notification emails both when 75% and 90% of your claim status checks have been used.
Overdue claims and expected payment windows
Rivet calculates average remit response time for each of your payers based on your claims data and considers this average time to be the "expected payment window" for that payer.
When a claim exceeds the expected payment window, it is flagged in red on the Non-Response worklist and considered "overdue." You can prioritize working only overdue claims by enabling the Only overdue claims toggle on the left of the screen.
Note: When the expected payment window for a claim is unknown, Rivet will assign an expected payment window based on the first quartile of other payers' median expected payment windows.
You can define your own payment windows for payers using the Custom payment windows area in the Non-Response settings. A custom payment window will override the Rivet-calculated expected payment window for that payer.
Assignment rules
You can set assignment rule in your Non-Response settings when you have multiple people who work non-response claims and need a way to automatically distribute those claims among them. When you build an assignment rule, any claim that matches the criteria for the rule will be automatically assigned to that specific user.
Custom statuses
You can build custom statuses for your Non-Response worklist in your Non-Response settings to customize your workflow in a way that fits your team and practice.
Rivet has three out-of-the-box Non-Response statuses:
Detected: A claim has been sent to the payer, but no electronic response has been received
Updated: A claim without a payer response has received a claim status check response from a payer
Processed: A claim has been adjudicated by the payer
Tip: If you have payers who only return EOBs by paper, you can create a status called "Paper EOB" to categorize claims billed to those payers.
Automations
Create automations through your Non-Response settings for claims to automatically move to a status when they meet specific criteria to help save your team from needing to perform repetitive manual actions.
Rivet has a default automation set up that moves the status of claims from Detected to Updated when you receive a claim status check response.
Tip: Create an automation rule that moves claims from payers who pay by a paper claim to the “Paper EOB” status. Since Rivet uses electronic remittance/EOB information to determine when a claim is paid, doing so will move those claims that will never have electronic remittances/EOBs off your Detected Non-Response worklist.
Tip: Create automation rules based on claim category codes/claim status codes so you can easily categorize them based on the action that needs to be taken on those claims. For example, you might create a rule that moves claim category codes A4, D0, and DR04 to a custom status of “No Record of Claim” to better help your team understand and address the issues with those claims.