Executive summary. Revenue integrity is the habit of checking whether the work a pharmacy performed was paid correctly, and settling the questions before they become losses.
Definition
Revenue integrity is the organized review of expected and received payment for prescriptions and services.
Where this work lives in Attergo
Revenue and finance teams start in Attergo Margin. Reconciliation shows which payments raised a question. Remittances, Missing Remittances, Exceptions, and Underpayment Cases hold the individual items. Assign each follow-up to the person who can confirm the payer response, and record the outcome before the case closes.
A prescription can be filled correctly and still deserve a payment review. What arrived may reflect the plan, patient responsibility, a dispensing fee, or an adjustment applied later. Reading those parts separately tells you what actually happened, rather than filing every short payment under one heading.
Review and follow up
Set a regular time to review the largest, the oldest, and the most repeated payment differences. Keep the claim response, the remittance advice, and any relevant contract or payer correspondence together, so a colleague can follow the question from start to finish without asking you.
Final decisions stay with the role your organization holds accountable for them. Record the decision on the item, with the evidence behind it, so the next person to open it does not start over.
Frequently asked questions
Who should use this Attergo workspace?
The role that owns the next action leads it: a billing specialist, an authorization coordinator, an inventory lead, a pharmacist, a compliance lead, or a finance reviewer. Access follows the role your organization assigns.
Referenced standards and further reading
- CMS: Electronic remittance advice ↗Centers for Medicare & Medicaid Services
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