Encounter → Service → Claim Flow
Overview
Encounter (clinical documentation) → matched to a Service Rule → generates a Service (claim line item) → you create a Claim → submitted to Stedi (clearinghouse) → sent to payer → payer adjudicates → ERA comes back → payments and adjustments are applied.
Key Mechanics
Encounter + client chart details → Ritten automatically generates a billable service via a matched service rule.
Services are regenerated (the entire service is replaced, not just updated) every time the encounter changes, until a claim is created.
Once a claim exists, services stop auto-updating and can be manually edited on the claim.
Without an active funding source on the client chart, encounters will not generate CPT codes even if service rules are configured.
Ritten submits claims to Stedi in JSON format; Stedi converts to EDI for the payer. EDI loop references in rejection messages may not map directly to what you see in Ritten's UI.
What Triggers an Automatic Service Rule Rerun
Admit/Discharge/Transfer changes, authorization updates, funding changes, and any modification to the encounter all trigger an automatic rerun of service rules.
Note: These same triggers can cause manually archived services to reappear. If services keep coming back after archiving, a chart change is triggering the rerun. Contact support if you need help identifying the cause.