Problem Statement

Claims must be adjudicated against the plan's rules, and a claim can't process until the right provider is assigned to it. Facets applies different selection logic depending on whether the claim is professional (837P) or institutional (837I), and assigning the provider across the nightly claim volume by hand is slow and error-prone. The harder case is a provider that isn't set up in Facets yet, which blocks the claim entirely until someone creates the record.

Automation Solution

This automation assigns a provider to claims each night using the appropriate 837P or 837I logic in Facets, and holds any claim whose provider isn't set up for staff to create the next day, then reprocesses it on the following run.