Provider Tiers and Status Exceptions

At Rivet, we understand the importance of providing accurate benefits to patients. To enhance the accuracy of estimate benefit attribution for our Automate and Estimate, we've introduced the Service Type Code (STC) Exception and Provider Tiers features. Service Type Code (STC) Exception allows you to customize the STC mapping at the Payer level, ensuring you get the best benefits for your specific needs. Providers Tiers gives you the ability to set a tier for a given provider.

In this guide, we'll walk you through the process of using these features effectively.

Understanding the STC Exception Feature
Accessing the STC Exception Feature
Creating and Deleting an STC Exception
Understanding the Provider Tiers feature
Creating and deleting a Provider Tier

1. Understanding the STC Exception Feature

The STC Exception feature is designed to address the problem of estimate accuracy. Currently, our CPT to STC mapping, which drives benefit selection, is uniform across all customer accounts, payers, and plans. However, some customers have found that they can achieve better benefits by sending a different STC than the Rivet default. With the STC Exception feature, you can now customize the STC mapping on your own account at the Payer level. This empowers you to fine-tune your benefit selection and ensure more accurate estimates for your specific needs.

2. Accessing the STC Exception Feature

To access the STC Exception feature, follow these steps:

Navigate to Account settings.
Click on the Estimates on the left near the bottom
Select the "Benefits" sub-tab.
Here, you'll find the option to customize your STC mapping for improved benefit selection.

3. Creating and Deleting an STC Exception

Creating and deleting an STC Exception is straightforward. Follow these steps:

Click add exception.
In the STC Exception section, select the payer for which you want to customize the STC mapping.
Choose the place of service relevant to your needs.
Specify the code (individual or range) that requires an exception.
Finally, select the STC that you want to send instead of the Rivet default. By creating this exception, you ensure that whenever the specified criteria are met, Rivet will send the STC you selected, thus optimizing your benefit selection.
To remove an existing exception, locate the exception you want to delete and click on the trash icon. The exception will be removed from your settings, and Rivet will revert to the default STC mapping for that specific scenario.

4. Understanding the Provider Tier Feature

The "Provider Tier" feature, introduces a valuable level of customization to your provider management within Rivet. By default, all providers in your account are set to Tier 1 and In-network status. However, this new feature empowers you to individually designate providers as Tier 2 or Out-of-network, aligning them with specific payer requirements. This customization has a significant impact on estimate accuracy, ensuring that your users receive precise and tailored cost estimates.

5. Using the Provider Tier and Status Exception

To access the Provider Tier, follow these steps:

Navigate to Account settings.
Click on the Estimates on the left near the bottom.
Select the "Benefits" sub-tab.
Click add exception.
Choose the provider(s) you wish to customize.
Identify the relevant payer(s) for these exceptions.
Specify whether the provider should be categorized as Tier 2 or Out-of-network.
To delete an exception click on the trash can icon next to the provider's name
On the follow-up prompt click delete to confirm the deletion.
To change an exception simply click on the edit icon next to the provider's name.

If you have any additional questions about STC Exceptions or Provider Tiers, feel free to chat in or send an email to success@rivethealth.com.