Claims lag: why nothing you see is "live"
Understanding claims lag is crucial to interpreting the insights Jiro provides into your practice. After a claim goes through submission, adjudication and remittance, it is closed, also called a complete claim.
Claims lag is the length of time it takes for different types of claims to go from submission to complete.
Lag by claim type:
- Pharmacy claims move fastest, with 90% reaching completeness in about 2 weeks.
- Open (in-process) claims are usually still moving through clearinghouses, with 90% reaching completeness in about 8 weeks.
- Closed (fully adjudicated) claims, usually from the payer itself, take about 6 months to complete.
- QE (Qualified Entity) claims, meaning Medicare and Medicaid claims specifically, take the longest, about 9 months to complete, because government adjudication runs longer.
While some Jiro features can use recent claims data, others must wait for the full lag cycle to complete. This depends on whether they use open or closed claims.
- Open claims carry a charge (billed) amount, but the paid amount may not be finalized yet. These provide insights with high recency but limited information.
- Closed claims have finished adjudication and carry an allowed or paid amount instead of just a charge. These claims have high lag, but provide the full picture.
Where this shows up:
Jiro automatically filters by claim type to provide accurate insights into your practice. This takes a slightly different form in each feature:
Clinical Tab: When viewing clinical metrics, you can select a Data Quality filter from Complete, Recent, and Latest views. You can choose between fully-verified-but-older data (Complete) or fresher-but-less-complete data (Recent/Latest).
This is also why a metric might look different this week than it did last month even though nothing about your practice changed, more claims simply finished adjudicating.
Financial Tab: All features use a 12-month rolling window, defined above the information window
Referrals Intelligence: Uses open and closed claims, as long as referring provider was noted
Reimbursement Intelligence: Uses exclusively closed claims, as it requires information about the payers decision
Denial Intelligence: Uses exclusively closed claims as they are all linked to remittance data
Encounter Coding Intelligence: Uses open and closed claims, from professional claims only
Consult/Discover/Research: Use your specialty, open and closed claims to deliver personalized material. Patient level insights will follow the same lag.