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At a Glance

Claim assignment rules route every claim to the right person automatically, using the same filters your team already uses on the Claims page. If you can build a worklist for someone on the Claims page, you can turn that worklist into a rule that assigns those claims to that person. Find claim assignment rules under Automations → Rules, on the Claim assignment card in the Claims group.
Anyone with access to the Automations page can view claim assignment rules. Creating and editing them takes write access to rules, which your practice admin can add to your role. See Manage Staff & Permissions.

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How a Claim Gets Assigned

Every claim assignment rule has three parts: Once one rule assigns a claim, no later rule runs on it. Here is how a denied Medicare Advantage claim that is 52 days old moves through four rules: The order matters: put your narrowest rules at the top and your broadest at the bottom.
✨Smart Tip: A claim that matches no rule stays unassigned. Add a catch-all rule with no priority so it runs last and picks up anything the other rules miss.

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When Rules Run

  • Automatically, whenever a claim is created or updated.
  • On demand, when you click Run rules next to + New Rule on the Claim assignment rules page. Use Run rules to assign the existing backlog after you set up or change rules. Run rules always runs every active rule; you cannot run a single rule on its own. The run happens in the background, so you can leave the page while the rules run.
  • Never over a manual assignment. If someone assigns a claim by hand, rules leave that claim alone.
Every assignment leaves a paper trail. The claim’s activity feed shows which rule assigned it, plus any later unassignment or reassignment. See Working a Claim: Context & Activity Feed.

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Rolling It Out to Your Site

1

Group your payers (optional)

Map payers into payer groups, such as Medicare Advantage or a state Medicaid plan, so a rule can route on one group instead of listing payers one by one. Your account manager can set these up. You can still route on a single payer without a group.
2

Write down how your team divides the work

There is no set format. You only need a clear picture of who works what, such as “Maria takes every denial from Medicare Advantage plans, and Sam takes anything over 90 days old.” Plain-language descriptions work best, because you can paste them straight into the AI rule builder in step 4.
3

Set up user groups (optional)

A user group is only a routing shortcut. When a rule assigns to a group, the rule picks one member by round robin or lowest count, and the claim belongs to that person, not to the group. Create groups under EHR → Preferences → User Groups.
4

Build the rules with Athelas Assistant

Athelas Assistant is the recommended way to build assignment rules. Go to Automations → Rules, click + New Rule, and paste in your description from step 2. Review the conditions, actions, and priorities the assistant builds before you turn the rules on. See Build a Rule with AI.
5

Run the rules and spot-check

Before you click Run rules, create a saved view on the Claims page for the claims you expect each person to get. After the run, group each view by Assignee and confirm every claim landed with the right person. See Organizing Your Claims Worklist.

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FAQ

Yes. Anyone can assign or reassign any claim, and rules never override an assignment made by hand.
Yes. Pick that payer as a condition and the rule routes those claims on their own.
Yes. Unassignments and reassignments are recorded in the claim’s activity feed. You cannot stop someone from unassigning a claim today.
Not today. Ask your account manager if your team needs one of these.
It stays unassigned. Add a catch-all rule with no priority so it runs last and picks up anything the other rules miss.