Fee schedule mapping is a crucial feature within our software that allows for detailed management of your fee schedules and what claims and estimates are associated with each fee schedule. This guide outlines the step-by-step process to navigate to and utilize the Schedule Mapping Tab effectively.
1. Navigating to Schedule Mapping
To access the Schedule Mapping page:
Go to Account Resources > All Payers.
Select a payer from the list.
Click on the Schedule Mapping Tab.
This page is your starting point for creating and managing mapping rules that determine how claims or estimates are mapped to fee schedules.
2. Creating a Mapping Rule
To add a mapping rule:
Click on Add Rule.
Select a fee schedule from the dropdown menu.
Choose criteria from the filter dropdown menu to apply to the rule.
Important: Rules are applied from top to bottom. You can include multiple criteria within each rule. To ensure accuracy, position rules with the most specific criteria at the top to prevent them from being overridden by more general rules.
3. Setting Filter Criteria
When adding filter criteria to a rule, you have the option to require multiple criteria. These criteria can be configured to match all or any conditions specified within the rule.
4. Understanding Criteria Options
The software provides a wide array of criteria to refine your mapping rules:
Insurance product
Is
Is Not
Contains
Provider Care type
Is
Is Not
Contains
Provider
Is
Is Not
Contains
Locality
Is
Is Not
Contains
CBSA
Is
Is Not
Contains
Credential Group
Is
Is Not
Contains
Place of Service
Is
Is Not
Contains
Patient Age
Is equal to
Is not equal to
Is greater than
Is greater than or equal to
Is less than
Is less than or equal to
Is empty
Is not empty
Zip Code
Facility Name and Address
Contains
Is none of
Is empty
Subscriber ID
Is equal to
Is not equal to
Contains
Does not contain
Starts with
Is empty
Is not empty
Is between
Subscriber Group Number
Is equal to
Is not equal to
Contains
Does not contain
Starts with
Is empty
Is not empty
Is between
Provider Taxonomy
Contains
Is none of
Is empty
Utilizing these criteria allows for precise control over how fee schedules are mapped, ensuring accurate rates for estimates and correct verification for claims.
For further assistance, feel free to contact our support team via chat or email at support@rivethealth.com.
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