At a Glance
- For every single encounter, charges = adjustments + payments. Athelas will seek out and fix any encounter for which this is not the case.
- Unpaid balances are readily visible. We can pressure insurance for payment, write them off, or push to PR.
- PR is only sent once charges are fully balanced out. This ensures patient billing accuracy.
- Everything is posted to a ledger, so your reports and statements get the same information from a single source of truth.
All About the Remittance Engine
Introducing the Remittance Engine v3, the next leap forward in Athelas RCM.
In our previous iteration — the v2 engine — remittances were prioritized daily by an algorithm that dynamically filtered, deduplicated, and sorted all available remittance data to create a final claim status. This approach provided ideal results in more than 99% of claims, but was susceptible to error when payers provided incomplete or conflicting remittance data.
To combat these flaws, our new v3 Remittance Engine was rebuilt from the ground up — improving virtually every aspect of the previous system, while preserving the most powerful elements of the original:
- Remittances are subjected to a stringent battery of tests for completeness. Only those with a passing grade will be eligible to become a part of your claim’s payment ledger.
- Every finalized encounter comes with a guarantee–the charges will equal the adjustments plus payments. We do this all automatically for you.
Remittances are now explicitly posted rather than algorithmically prioritized and revenue is locked to specific posting dates, leading to consistent revenue analytics across all tables and pages.
Because of this shift in functionality, we can provide increasingly nuanced timelines of payments, draw stricter boundaries between valid and invalid PR, categorize encounters as ‘Finalized’ when no remaining action is needed, better detect Underpayments, as well as a host of other improvements.
Insurance Paid Amount and PR) will now update in real time! No more waiting for the nightly data refresh to see the latest status of your claims. ✨ Key Benefits of the New Approach
There are a variety of advantages to our new remittance engine. Here are the highlights:
- Patient Responsibility is more accurate Because remittances are more aggressively screened and unbalanced claims don’t progress to the patient, the risk of statements including inaccurate PR has been significantly reduced.
- Revenue is locked to specific dates Now that claims have discrete moments where remittances are ‘Posted’ to the claim’s ledger, posted revenue will forever be associated with a specific date. Any later changes to revenue will have their own posting dates, creating a clear timeline payment.
- Fixing issues is simpler and faster Because the v3 engine triggers specific Posting actions rather than attempting to compute a state of the claim, it’s now easy to add in manual actions. Your staff and Athelas Ops will be able to Post, Reverse, or Adjust Balances with just a few clicks.
- A/R Balances are clearer Our new approach places greater focus on the remaining ‘Balance’ for a claim, which starts as the Billed amount and decreases as payers deliver their adjustments and payments. This makes it much simpler to track what remains unpaid on any given claim.
- Tracing coordination of benefits is streamlined Refinements to our interface also give greater visibility into how balances flow from one payer to the next, highlighting any issues and which payers those issues are associated with.
🌐 New Posting Process
Here’s how remittances will be Posted to your claims via the v3 Remittance Engine:
Each new remittance will comprehensively be tested for completeness
- Remits that Pass the completeness check flow into a queue to be Posted
- Remits that Fail the check flow to a Manual Review process for resolution
Once processed, each remittance will be inspected in the context of all the previously posted remittances on the encounter
- Remits that fit seamlessly into the encounters’ sequence of remittances will be posted automatically
- Remits that don’t fit seamlessly, but match our growing library of ‘auto-repair’ scenarios will be automatically modified and then posted
- Remits that don’t match either of the above will be passed into another Manual Review queue for our operations team to cleanup and resolve.
Finally, our ‘Adjustments Engine’ will review the encounter as a whole and perform any actions you’ve defined to resolve the claim.
For example:
- Writing off a balance
- Pushing a balance to PR
🖥️ Updated Interfaces
With the release of the Remittance Engine v3, most interfaces in Athelas Insights will receive at least minor modifications to bring them in line with the new approach. So far the following pages have been revised and updated for REv3:
Revenue Analysis (infrastructure changes only)
Denials Page (infrastructure changes only)
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