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Fee Schedule Mapping

Learn how to map your fee schedules to specific claims or estimates.

Updated over a week ago

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:

  1. Click on Add Rule.

  2. Select a fee schedule from the dropdown menu.

  3. 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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