Discover the full potential of managing underpayments with Rivet's new Underpayments Projects Dashboard. This tool allows you to organize, track, and manage appeals against payer underpayments effectively. Detailed metrics, note-taking capabilities, and reminders enhance your project management experience. This article outlines key features and how to use Underpayment Projects in Rivet.
1. Accessing Projects
To access projects in Rivet, navigate through the Payers dropdown to Underpayments Projects.
Alternatively, you can access the Projects dashboard directly from the top right corner of the Underpayments worklist.
2. Projects Dashboard
The Projects dashboard has two main sections: active and completed. Within the Active tab, there are two sections for projects: Sent and Suggested & Drafts. When projects have all their issues in a Recovered or Resolved status, Rivet will automatically move it to Completed status, and it will appear in the Completed tab. If the project is filter-based and new claims matching those filters appear in the worklist, the project will detect them, and it will move back to the Active tab.
Sent Projects: These are projects that contain issues that you’ve marked as Sent from within the project details page. Sent projects have more metrics on the cards.
Suggested Projects: these are projects that Rivet has identified as something that you could potentially appeal with the payer. There are 4 types of suggested projects:
Escalator: These are projects where your contract indicates that there should be an increase in rate year to year, and Rivet has identified underpayments where this is not happening
Modifier 50 or 22: these are projects where you are not paid the contracted rate for these modifiers
Carveout: These are projects where your contracts indicate you have negotiated a special rate and Rivet detected that it wasn’t being paid at the carveout rate
Rendering Credential: These are projects where the provider isn’t paid according to the credential they have.
Draft Projects: Projects in the draft stage may include notes, reminders, or assignments. These projects also appear when you create projects directly from the worklist.
Completed Projects: When you complete a project you can manually move it to the completed status or if all issues are in a recovered or resolved status it will automatically move to completed. You can also manually move a project back to active if needed.
3. Dashboard Metrics
Along the top of the dashboard, you’ll find the following metrics:
Recovered for the current month
this is the amount of payment variance that has been recovered through working a project.
Projects completed for the current month
This is the number of projects moved to the Completed status, either manually, or automatically by Rivet.
Total outstanding in sent projects
This is the amount of payment variance that you’ve appealed with the payer but hasn’t been recovered yet.
Amount recovered for the current year
These are the recoveries associated with projects that were recovered in the current calendar year.
4. Creating Projects
There are two types of projects you can create. You can build filter-based projects, which will automatically capture new issues as they come into the worklist and alert you to ongoing issues. You can also create simple bucket projects, where you manually select the issues that are included in that project, and nothing is automatically added. Any additional issues will need to be added from the worklist manually.
Filter-based Projects
Create by adding desired filters to the worklist and clicking "Create Project."
Review and name your project.
You can access your project from the notification that appears.
You can also navigate to the Drafts section of the Project Dashboard.
Bucket Projects
Select claims you wish to include from the worklist, ensure they are from the same payer, and click "Create project."
Review and name your project.
You can access your project from the toast notification that appears.
You can also navigate to the Drafts section of the Project Dashboard.
5. Managing Project Pages
Projects can be managed with several different tools. Each project has its own section for notes. These notes are for managing the project and will not be attached to the download.
Projects will also have a timeline, so you can easily track who was working on which project, and what they did. There are also two different ways to view the issues in a project.
Notes & Reminders
To make a note into a Reminder, simply click Project actions > Notes & reminders.
Add your note.
Select the date you want to be reminded.
Then click Save.
You’ll see the reminder in the Notes and Reminders sidebar, and you can edit the text or the reminder date as needed.
Timeline
Projects will also have a timeline, so you can easily track who was working on which project, and what they did.
Access the timeline from Project actions:
The timeline will show any of the following actions:
Project creation date
Bulk status changes
Project status updates (completed to sent, sent to completed)
Notes added
Project assignments
Batch view
In batch view, you can easily see new issues that you haven’t sent to the payer yet, as well as each batch of sent issues and the date they were sent. Each card has the recovered stats of the batch. Click on a batch to see the claims within it.
List view
In list view, you can see all the issues in the project in one table. This makes it easy if you need to take action on all the issues, or you want to download them all at once.
6. Sending Issues
Issues sent from Projects
Once you’ve investigated the underpayments in a project and you’re ready to appeal them to the payer, mark them as Sent from the project. Marking issues as Sent will lock them to the project, and enable the recovery tracking for the project.
If you download all the issues in a project, Rivet will prompt you to do this.
When you mark issues as Sent, you’ll see the metrics at the top of the Project details page update to reflect the outstanding amount. Once the payer reprocesses the sent claims and you start to recover the variances, you’ll see the amount recovered reflected in the “Total Recovered” box.
Once the project issues are set to Sent, the project will then appear in the Sent project status, and you’ll also see the stats on the Dashboard update to reflect the new outstanding amount.
Issues sent from the worklist
If you’ve already started a project and sent claims off from the worklist, we’ve made it easy to bring that into a project and start tracking your metrics. You will see a batch card titled “Sent from worklist”:
When you click into the details of this batch, you’ll be able to decide whether to track these claims as part of the project or not.
Issues sent from other projects
Because statuses are at the claim level, when you appeal claims for one project, you could be sending lines that match the filters for another project. Rivet alerts you to this with a batch titled “Sent from another project”. These are claims that are already in appeal with the payer, and their stats won’t be tracked as part of the current project.
7. Bulk worklist selections
Bulk worklist actions are now supported on selections greater than 10,000 claims. We have also added the ability to bulk select within the worklist by using shift-click.
To bulk select select the checkbox to the left of the claim.
Go to where at on the list you want to bulk select and hold shift and click the checkbox to select everything in between your selections.
You can also make multiple selections on a worklist with a shift click. By navigating to the next selection of claims clicking the check box and then shift-click to make another large selection.
For any further questions on the underpayments projects dashboard, contact our support team via chat or email support@rivethealth.com.