At a Glance

The Billing Rules Engine page lists all active and inactive billing rules implemented by a collaborative effort between your organization, an Athelas account manager, and our engineers.

The two types of rules found here are categorized as Global or Site. More on that later in this guide.

To make changes to rules, contact your account manager.

The Billing Rules Process

Early in the Athelas onboarding process for your organization, an account manager collaborated with your organization’s administrators to incorporate all existing billing rules, updates to those rules, and any new rules requested into Insights.

These rules, along with any added manually since then, comprise the list visible on the Billing Rules Engine page.

You can filter this list to show only Active, Inactive, or All.

Types of Rules

• Global Rules

  Global rules are standardized, stock rules available to all organizations using Athelas Insights. These rules tackle the most common claim adjustments to minimize rejections and denials and maximize collections for your practice.

• Site Rules

  These rules are specific to your site.

The explanatory notes on these are editable. Click the ‘Edit’ button below the explanation to make changes.

Code for Site Rules

Scroll to the right in the Site Rules tab and you can see the trigger for each rule, the actions subsequently applied, and who created the rule.

This is the first place to check if a site rule is failing in some way.

View Active Rules on a Claim

To see which rules were applied to an individual claim, visit the Claim Details page. Click into a claim, then switch the the ‘Submissions’ tab. Choose a submission to expand and click ‘x rules applied.’

View dry run results of billing rules engine on Encounter Details

Features In Development

• Be able to view diff or pre and post billing rules on the claim payload

Features Not Supported

• Allow sites to update billing rules

Further Assistance

We’re here to help! Please get in touch with support@getathelas.com if you’d like some hands-on assistance.