This article aims to show you the main features we are adding and changing in Payer performance with the transition from a line item-based workflow to a claim-based workflow.
Claim Summary: see what’s going on at a glance
Simplified Statuses + Assignments
Explanations front and foremost:
Simplified Transaction History
Collapsible sidebar sections
Payment Issue Filter
Overriding a fee schedule
1. Claim Summary: see what’s going on at a glance
Now, you can see the total amounts billed, expected, and allowed across all items on a claim. Payment variance is also summed across all lines. Underpayments won’t appear unless there is a total variance on the claim, so you’ll spend less time tallying up variances to see if it’s something you need to work.
You’ll see how many claims (837) and remits (835) are associated with the claim, as well as how many of those are from the primary or secondary payer.
2. Simplified Statuses + Assignments
You can now assign and change the status of an entire claim, instead of having to do it line item by line item. The status and assignee on the claim live in the top right:
3. Explanations front and foremost:
Clicking on any line will open the Explanation toggle and highlight the explanation for the code so you can easily find what you’re looking for.
Other codes can be collapsed as well, so you don’t get lost in a long explanation.
4. Simplified Transaction History
Activity (comments + timeline) and Transaction History are now tabs underneath the explanation. Transaction History has been simplified. You can get the complete, line-by-line transaction history by clicking “View claim”.
5. Collapsible sidebar sections
The sidebar is now easier to navigate, with collapsible sections. Focus on the information you need to work the underpayment.
6. Payment Issue Filter
The Underpayments/Overpayments filter has been replaced by a Payment Issue filter, which is more granular, so you can hone in on a specific issue type. The metrics at the top of the worklist reflect what’s been selected.
7. Overriding a fee schedule
We have added the ability to override the fee schedule for an underpaid claim. You can override this from the Overview section on the left by clicking the pencil icon next to the fee schedule name.
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: Transitioning to the Claim Level Workflow (Underpayments)