GoRev Independent Dispute Resolution (IDR) Module

The GoRev IDR Module streamlines the complex and exceptionally tedious process of managing payment disputes between healthcare providers and payers. Designed to support both open negotiation and formal Independent Dispute Resolution (IDR) workflows, this module centralizes communication, documentation, and decision tracking, automated tracking of timelines and case progress into a single, intuitive user interface.

Navigating to the new Dispute Resolution module

From Navigating Patient Overview first make sure you have the correct visit selected and then click the Dispute Resolution button

You can also access this module via workflow here:

Create (Add) a new IDR

Before you begin populated IDR information you will need to click the Add/Edit IDR button. This will pop a new window asking you to name your IDR and attach a specific eob to it.

Name your IDR in the Entry Name box. This is a name that will show up on reports and data exports.

Specify the type of IDR as Federal NSA or State NSA

And be sure to highlight the specific EOB you want this IDR attached to.

Lastly specify the Encounter Type and click Update/Add IDR. Your window should look something like this below before saving.

For accounts with multiple EOBs or where you are filing different IDRs for different sets of codes you can create multiple IDRs using the above method.

Enter Insuror Info

Clicking Copy From Encounter will pull the insurance company's information into this section for you. It pulls dynamically from either the 835 received from the insurance or the insurance you have specified within GoRev. Pulling from the 835 helps ensure your information matches the insurance company's.

Enter Negotiation Details

The Negotiation Details section is meant for tracking Open Negotiations (not formal IDRs which we'll get to further down within the module). This section allows for entry and tracking of multiple offers.

IMPORTANT: Only the most recently added non-voided offer from this section will be used within the Dispute Resolution Analysis report.

First, enter a name for your offer. This name will be how you pull it back up in the future and what it is referenced by on reports.

From there you can edit each individual offer's details on the right after selecting (highlighting) the offer in the grid on the left.

Most fields are self explanatory except for Negotiation Amount. This field is a dynamic filed based upon rate sources you can select further down. We will discuss how to use the rate sources in the next section of this guide.

Open Negotiation Ends, 4-Day Window Start and 4-Day Window End are all dynamically populated dates based upon actual business days taking CMS' approved holidays into consideration.

If you check the Voided box it will consider the offer to be not used or relevant and will remove it from reporting. It will still show in this section and can be unvoided by unchecking the box

Setting Negotiation Amount using Rate Sources

Click on in the navigation tree on the left and you will be scrolled down to the below section.

First step is to select which procedure code lines are included in your IDR (you may have multiple IDRs covering different sets of codes). Double click a service line row to toggle the included check on or off.

will apply your rate source to all included lines.

will only apply the rate source to the line you have selected (highlighted)

See further down for how each rate source functions.

Fixed Rate

This fixed rate box allows you to enter in a currency value that will be prorated across all included service lines if you click Apply Rate or will apply only to the selected service line if you click Apply To Selected.

For example below I selected G0378 and applied a 1200 rate just to that line by clicking Apply To Selected

Or I could have the 1200 prorated across all lines by clicking Apply Rate

Percentage rate

Percentage rate allows you to apply a percentage of charges as your negotiation rate. The same Apply Rate vs Apply To Selected logic applies here as well. Below shows 80% Apply Rate across all service lines.

Other rate percentiles

Further down you'll see a percentile set of rates. These are based upon your actual reimbursements from the insurance carriers. Payer Specific only looks at the payments for the specific payer on the account across all your claims. All Payer looks across all payers all claims.

Click into a specific percentile bucket and it will apply to all included service lines. The box will change to green indicating you have selected and applied it. Below shows the 85th percentile All Payer rate being applied.

Formal IDR Process

The formal IDR process sections begin with Entity Selection and Case Initiation. Click in the left navigation tree to scroll down to this section.

As you work through the IDR process you will come back to this section to populate selected and confirmed entities.

The entity lists are populated based upon the CMS certified IDR Entity list which can be found here

https://www.cms.gov/nosurprises/help-resolve-payment-disputes/certified-idre-list

You can track the date you received the payment request, the amounts, payment method, date fees are due, and date you paid the fees in this section.

Determination and offer status tracking

Click to scroll down to this section.

If your formal IDR matches your open negotiation offer you can simply click Copy from Open Negotiation.

This will pull in your offer information as shown below

Otherwise you can edit 1 or more rows at a time setting your offer, Insuror offer, determination dates, status, submission dates, and final determination (amount insurer settled to).

Be sure to set the payment due date as this can be tracked in reporting and can be used to ensure insurance carriers are held accountable.

IMPORTANT, be sure to click anytime you are changing information on service lines in this section.

Linked payments

This section will only show payments received AFTER your IDR submission dates. It will then allow you to attach payments to either fees related to the IDR process or the actual insurance carrier payment of the settled rate. Tracking can be done via reports.

Quick Forms

This section is a quick view of our Print Forms. If you have created custom dynamic print forms related to your IDR processes you can quickly access them using this section.

Most of the new fields related to this IDR module are usable dynamically within our print forms module. They can be found within the Idr section of fields (these are related to the formal dispute process)

or in the IdrOffer section of fields (these are fields related to open negotiation)

Ai Forms

This section utilizes OpenAI to draft open negotiation letters, IDR position statements, and assist with summarizing the medical record. Usage of AI requires an addendum to your agreement and will incur additional costs. If you are interested in this section please submit a support request.

Click

The system will send a request to the AI model. This processing can take up to 90 seconds depending on Ai load.

The letter is drafted into the free text window. From there you can tweak as needed before clicking This saves the letter to the patients files in File Management. Download and use as needed from there.

Click the

and the Ai will generate a position statement to assist you with submission into arbitration.

Click

and then select your medical records (CTRL + click to select multiple files). Then click Process Documents. The Ai will create a summary of medical care you can use to assist with arbitration submissions.

Finalize your IDR or specify past due

These checkboxes at the top right can be used to help track IDRs truly settled in Open Negotiations (aka no formal IDR process needed). You can also track accounts past submission deadlines removing them from reports and your active work queue. Lastly, you can track Government Insurances that do not qualify for these dispute resolution processes.

Reports

A new series of reports related to this IDR module will be available in a reporting tile titled "Dispute Resolution Analysis"

Guide on this coming soon.

Additional Resources

GOREV SUPPORT TEAM

If you have any additional questions or concerns regarding this tutorial, please contact the GoRev Support Team by phone at (317) 794-3900 or by email at

ask@gorev.com

Note: Always submit an IT Support Ticket detailing the problem that you are experiencing with this portion of GoRev, if possible, as this will give GoRev Support Agents access to information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see the GoRev IT Support Ticket Creation Tutorial for assistance

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