Data types that can be imported into Rivet

837 files

An ANSI x12 837 is an electronic claim transaction submitted to an insurance provider. 837 files contain information regarding medical services provided, and the cost of treatment.

How does Rivet use claims data?

Payment Variance: when Rivet has both 837 and 835 files, it is able to match them in order to detect underpayments and report on denials.

835 files

Also known as an Electronic Remittance Advice (ERA), an ANSI x12 835 is an electronic transaction sent from an insurer to the healthcare provider in response to an 837. The 835 provides claim payment information and documents the EFT (electronic funds transfer).

How does Rivet use remittance data?

Estimates: Rivet can use this data to generate claims-based estimates for future dates of service.
Payment Variance: remittance data (combined with fee schedules) allows Rivet to detect underpayments and report on claim denials.

Patient demographic data

Patient demographic data refers to all of the non-clinical data about a patient, including name, date of birth, address, phone number, email address, sex, race, etc. When this data is delivered via an HL7 message, it comes through in an ADT feed, which stands for "Admit, Discharge, and Transfer."

Patient appointment data

Patient appointment data refers to all of the scheduling and appointment information related to a patient, including appointment date and time, resources, services, location, and any other pertinent information regarding the appointment. When this data is delivered via an HL7 message, it comes through in an SIU feed, which stands for "Schedule Information Unsolicited."

Required data by Rivet product tier

Patient Pricing	837s	835s	Patient demographic (ADT)	Patient appointment (SIU)
Comply	n/a	n/a	n/a	n/a
Estimate	n/a	optional	required	required
Automate	n/a	optional	required	required

Payer Performance	837s	835s	Patient demographic (ADT)	Patient appointment (SIU)
Benchmark	n/a	n/a	n/a	n/a
Maximize	n/a	n/a	n/a	n/a
Audit	required	required	n/a	n/a

Claim Resolution	837s	835s	Patient demographic (ADT)	Patient appointment (SIU)
Understand	optional	required	n/a	n/a
Resolve	optional	required	n/a	n/a

Four main types of healthcare integrations

Comparing Actual Results with Rivet

Data types that can be imported into Rivet

837 files

835 files

Patient demographic data

Patient appointment data

Required data by Rivet product tier

Patient Pricing

837s

835s

Patient demographic (ADT)

Patient appointment (SIU)

Payer Performance

837s

835s

Patient demographic (ADT)

Patient appointment (SIU)

Claim Resolution

837s

835s

Patient demographic (ADT)

Patient appointment (SIU)