> ## Documentation Index
> Fetch the complete documentation index at: https://docs.athelas.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Claim Assignment Rules

### 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.

> [!NOTE]
>
> 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](https://docs.athelas.com/insights_admin/my_practice/manage_staff_permissions.md).

## How a Claim Gets Assigned

Every claim assignment rule has three parts:

| **Part** | **What it does** |
| :- | :- |
| **Priority** | Rules run against each claim in priority order, and the first rule that matches assigns the claim. **0** runs first, then 1, then 2, and so on. A rule with no priority runs last. |
| **Conditions** | Every Claims page filter is available as a condition, with the same values. Need a condition that does not exist yet? Ask your account manager; new filters and conditions are built on request. |
| **Action** | Assign the claim to a single user or to a user group. For a group, **Round robin** spreads claims evenly across the members, and **Lowest count** gives the next claim to whichever member has the fewest. |

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:

| **Priority** | **Rule** | **Result** |
| :- | :- | :- |
| 0 | Coding denials | No match, so the next rule runs |
| 1 | Medicare Advantage | **Match. Assigns the claim.** |
| 2 | Aged over 45 days | Not reached, even though the claim is over 45 days old |
| None | Catch-all | Not reached |

The order matters: put your narrowest rules at the top and your broadest at the bottom.

> [!TIP]
>
> ✨**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.

## 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](https://docs.athelas.com/insights_biller/claim_details/working_a_claim.md).

## 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](https://docs.athelas.com/insights_biller/automations/create_a_rule.md#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](https://docs.athelas.com/insights_biller/claim_details/organizing_your_claims_worklist.md).

## Related Guides

* [**The Rules Tab**](https://docs.athelas.com/insights_biller/automations/the_rules_tab.md) covers reading, editing, and dry running rules of every type.
* [**Create a Rule**](https://docs.athelas.com/insights_biller/automations/create_a_rule.md) covers building a rule with AI, by cloning, or field by field, and submitting it.
* [**Organizing Your Claims Worklist**](https://docs.athelas.com/insights_biller/claim_details/organizing_your_claims_worklist.md) covers saved views and grouping claims by assignee.

### FAQ

> [accordion] Can team members still assign claims to themselves?
>
> Yes. Anyone can assign or reassign any claim, and rules never override an assignment made by hand.

> [accordion] Can I route claims from one payer without creating a payer group?
>
> Yes. Pick that payer as a condition and the rule routes those claims on their own.

> [accordion] Is there a record when someone unassigns a claim?
>
> Yes. Unassignments and reassignments are recorded in the claim's activity feed. You cannot stop someone from unassigning a claim today.

> [accordion] Can I route by CARC, RARC, or denial type, or filter the Claims page by user group?
>
> Not today. Ask your account manager if your team needs one of these.

> [accordion] What happens to a claim that matches no rules?
>
> It 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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