Rivet’s Payer Performance product is transitioning from a line item-based workflow to a claim-based workflow because of your feedback. While we try at all costs to avoid making product changes that affect customer workflow, we’ve heard feedback asking for a claim level view for a long time, and we genuinely believe that this transition will make Rivet better.
Why we are changing to a claim-level workflow
When will this transition happen
What functionality will be transitioned
How existing line item statuses will transition
1. Why we are changing to a claim-level paradigm
A claim level paradigm will make Rivet better because it more closely matches how underpayments are worked outside of Rivet. Some examples:
When you appeal an underpayment, you send the whole claim at the same time, and all the lines on the claim are reprocessed.
When you call a payer about an underpayment, they’re looking at the whole claim at the same time.
EHR/PM systems work at the claim level
Besides more closely matching how underpayments work outside of Rivet, we anticipate a claim level paradigm will improve the workflow and efficiency of underpayment teams because:
When an underpayment project is submitted to a payer, they will usually block any other projects related to that time frame, so it’s important to see all the issues on a claim at once.
Claim level detail view will also show a summary of the total payment variance across all line items, aggregating which line items would be most beneficial to recover.
While the underpayment detail view is being updated to this new paradigm, the worklist will remain broken out by line item. You will be able to see the payment issue (Underpaid, Overpaid, Retracted, Recovered) from the worklist, and still be able to apply all the same filters and trend your underpayments to find projects.
We understand that this is a disruptive change, and we are putting all our efforts into making it as smooth as possible.
If you have concerns about this transition, please schedule time with your customer success manager as soon as possible.
2. When will this transition happen
You have two weeks before we transition your account from being line item-based to being claim-based. This transition will occur on 10/24/23. Once you transition to a claim level workflow, you cannot transition back to a line item workflow. You will receive an invitation to do training on this new paradigm. If you have concerns about this transition, please schedule time with your customer success manager as soon as possible.
3. What functionality will be transitioned
Functionality that is transitioned automatically:
Line item statuses will become claim level workflow statuses
Saved views
Assignments
Worklist
As mentioned above, the worklist will remain the same, with the difference that if you change the status on one line item, it will update the status of other lines on the claim automatically.
4. How existing line item statuses will transition to the claim-level workflow
We will be using the following logic to transition customers’ statuses from Rivet’s old line item workflow to our new claim level workflow.
If no user actions have been taken on any line item in a claim:
If any line items are underpaid or overpaid, the whole claim status will be Detected.
If no line items are underpaid or overpaid, and any line is retracted, the whole claim will be Retracted.
If no line items are underpaid or overpaid, and any line is recovered, the whole claim will be Resolved.
If there are user actions on any line item in a claim, then the most recently updated line item status becomes the status of the entire claim.
If you have further questions about the transition to claim-level workflow please schedule time with your customer success manager as soon as possible. or send an email to support@rivethealth.com.
Suggested Next Article: Understanding the Claim Level Workflow (Underpayments)