🚀 Features & Enhancements

Centralized Goal Custom Fields

Description

• Goal Custom Fields have been enhanced to allow organizations to create and manage reusable custom fields across multiple goal templates.
• Previously, custom fields were configured individually within each goal template, requiring organizations to recreate the same fields across multiple templates.
• Custom fields can now be created once at the organizational level and applied to any number of goal templates, reducing duplicate configuration and improving consistency across workflows.
• Custom fields can also be incorporated into goal export templates, allowing organizations to report on additional goal-specific information without creating duplicate export fields.

Configuration

Navigate to Templates → Goals to access the new Goal Custom Fields section above the existing goal templates table.

• Select Add Custom Field to create a new field and configure its name, response type, and available answer options.
• Supported response types include:
  • Yes/No
  • Choose One
  • Choose Many
  • Date

• Custom fields can be designated as required.
• When creating or editing an individual goal template, administrators can select from existing custom fields and associate them with that template.

• The same custom field can be associated with multiple goal templates without needing to recreate it.
• This functionality is available to organizations with the Enable Customizable Goals setting enabled.
• When goal templates are shared from a hub organization to a sub-organization, their associated custom fields are included. Existing template-sharing permissions apply to those fields, including read-only permissions.
• When configuring a Goal Export Template, custom fields associated with the selected goal template are available to include in the export.
• Each reusable custom field is available as a single export field, even when it is associated with multiple goal templates, eliminating the need to configure separate export columns for each goal template.

User Experience

• Users will continue to interact with custom fields when creating goals on member profiles, with no changes to the existing goal creation workflow.
• Custom fields associated with a selected goal template will appear when creating a new goal.
• Users can complete these fields according to their configured response types and requirements.
• Organizations can use custom fields to capture additional information about goals, such as urgency, priority, or other workflow-specific classifications.
• Custom fields are informational and do not automatically generate notifications, alerts, or To-Dos.
• When exporting goal data, users can include custom fields in their export templates, provided those fields are associated with the goals being exported.
• Exported goal data includes the selected custom fields as individual columns, allowing organizations to consistently report on the same information across different goal types.

Member Experience

Not applicable. This enhancement improves internal goal configuration, management, and reporting without changing the member-facing experience.

Claims Management Rebuild

Description

The Claims page has been completely rebuilt to improve performance, simplify navigation, and provide a more intuitive claims management experience. The redesign includes faster loading times, customizable table columns, enhanced filtering, improved claim details, and greater visibility into claim processing.

Configuration

• No additional organization configuration is required.
• Users can customize displayed columns and their order, with preferences saved in their browser.
• The enhanced claim timeline remains in beta pending additional production validation.

User Experience

Improved Claims Page Performance and Layout

The Claims page now supports faster loading and navigation, with a more compact table that displays additional claims and information without unnecessary scrolling. Updated financial summaries provide a clearer overview of invoiced amounts and claim statuses.

Enhanced Filtering

A redesigned filtering panel organizes claim filters into categories, allowing users to combine claim statuses, date ranges, payers, organizations, and other criteria. Quick-access filters provide shortcuts to commonly used claim views.

Customizable Claims Table

Users can show, hide, and reorder table columns to prioritize the information most relevant to their workflows. Column preferences are saved in the browser.

At-a-Glance Claim Information

Hovering over member names, claim amounts, and claim statuses provides additional contextual information without requiring users to open individual claims.

Updated Financial Summaries

Compact financial summaries display invoiced amounts and claim totals (top, right corner of the claims page), with detailed status breakdowns available on hover.

Redesigned Claim Details and Service Lines

Claims now open in a larger, tabbed interface with dedicated sections for Summary, Services, Claim, Payer Responses, and Payments. Users can navigate between claims directly and identify the activities associated with individual billed service lines.

Enhanced Claim Timeline (Beta)

The new claim timeline provides a more detailed history of claim activity, grouping multiple submissions and displaying processing milestones, statuses, and dates. This helps users understand claim progression and identify potential delays.

Note: The enhanced claim timeline remains in beta while additional production validation is completed.

Member Experience

No direct changes to the member experience.

Claim Overrides: Manual Claim Editing

Description

Users can now manually edit claim information through a new Edit Claim action, allowing them to correct billing information without modifying the underlying member record. This provides greater flexibility in resolving claim errors and making claim-specific adjustments before regenerating a claim.

Configuration

• No additional organization configuration is required.
• The Edit Claim action is available through the claim's Actions menu.

User Experience

Manual Claim Editing

Users can modify supported billing fields, including claim conditions, service lines, procedure modifiers, diagnosis codes, provider information, and facility details. Existing claim information automatically populates the editing interface, allowing users to update only the fields requiring correction.

Claim-Specific Overrides and Regeneration

Changes apply only to the selected claim and are not written back to the member profile. Users can save updated information and regenerate the claim using the overridden values. Manual modifications are tracked, including who made the changes and when, and previously applied edits can be reset.

Member Experience

No direct changes to the member experience. Claim overrides do not modify information stored in the member's profile.

AI-Powered Claim Recommendations

Description

AI-powered claim recommendations provide users with plain-language explanations of claim errors and suggested corrections to help resolve issues more efficiently. Users can review AI-generated recommendations, apply suggested changes to claim fields, and regenerate claims directly within Pear Suite.

Configuration

• AI claim recommendations are controlled through a new organization-level setting.
• The feature is enabled selectively for eligible organizations, including those with RCM-managed claims.
• AI functionality remains disabled for organizations without the necessary approvals or applicable data-use permissions.
• Manual claim editing remains available independently of the AI setting.

User Experience

AI Error Explanations and Recommended Corrections

When a claim encounters an error, AI can generate a readable summary explaining the issue and recommend specific corrections. Users can provide optional guidance to refine the recommendation and regenerate the AI summary.

Applying AI-Recommended Fixes

Users can apply recommended corrections directly within the Edit Claim interface. Suggested modifications are highlighted for review before saving, and the claim can then be regenerated using the updated information.

Member Experience

No direct changes to the member experience.

🛠️ Issues & Fixes

Activity Import Calculation Case Sensitivity

Fixed a discrepancy where activity imports accepted answers with different capitalization than the configured response options, but calculations using those imported values did not recognize them correctly. Calculations now process imported answers regardless of capitalization, ensuring accurate results.

Google Calendar Sync Issues

Resolved issues affecting Google Calendar synchronization to improve the reliability of calendar syncing between Pear Suite and connected Google Calendar accounts.