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Claims Tools

BizOPS uses Retool to manage claim resubmissions and rate changes.

We have a dedicated Claims folder in Retool where all claim-related tools are stored.

Claims Batch Resubmission Tool​

URL: https://retool.pairteam.com/app/claims-batch-resubmission

This tool allows bizOPS to resubmit claims in batches.

All the uploaded files and results are stored in the S3 bucket change-healthcare-prod

  • Uploads are stored in the folder: batch_resubmit_claims/uploads
  • Processed uploads are stored in the folder: batch_resubmit_claims/processed

Process​

  1. Ops prepares a CSV file containing a list of claims to be resubmitted.
    1. It can be a Looker-exported CSV file.
  2. Upload the CSV file to the tool.
  3. Click the "Process Batch" button.
  4. The tool will resubmit the claims and email the results to the user.

Additional instructions are provided within the Retool page.

Results​

The resubmission results will include the original headers sent by the user, plus the following additional fields:

  • Result: SUCCESS or FAILED
  • Error Type and Message
  • Patient ARC Link
  • New Claim Details: Information about the new claim created as a result of the resubmission.

Claims Rate Management Tool​

URL: https://retool.pairteam.com/app/claims-rate-management-tool

This tool allows BizOPS to view and update rates for billed services.

It is particularly useful when there is a rate change, enabling BizOPS to set rates effective on future or past dates.

The applicable rate for a claim is determined based on the claim's date of service.

Features​

  • View current rates, with the ability to sort and group by HCPCs Code, Payer, and Modifier
  • View historical rates, including rate amounts and their effective dates
  • Add new rates, with options to set future or retroactive effective dates
  • Edit and update existing rates
Note

Whenever we start to bill a new service (e.g., a new combination of HCPCs code, modifier, or payer), we need to ensure that a corresponding Finance::BilledService record is created to reflect the new service. You can create the initial rate at this time (Finance::ServiceRate), or leave it blank and use the Retool application to set the first rate later.

Specs​