The Rules Tab

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At a Glance

Every claim, encounter, and payment that moves through Insights passes through rules: small IF/THEN decisions that clean up data before it reaches a payer, block submissions that would be rejected, and route work to the right place. The Rules tab puts all of them in one table, described in plain language, so you can see what your practice automates without reading code or opening a separate screen for every engine. Find it under Automations → Rules, then choose the rule engine you want to look at.

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What Is a Rule?

A rule is a single IF these conditions are true, THEN take one or more actions statement. One rule can fire several actions off the same set of conditions. Rules are grouped and run by a rule engine, the system that evaluates each rule in order and applies the ones that match. Each engine has its own tab under Rules. Engines you are likely to see include: Every rule ID carries a prefix for the engine that owns it, so an ID alone tells you where a rule lives: CLM-1716 is a Billing rule, PCL-561439 is a Submission blocking rule, ADJ-434765 is an Adjustments rule, and APT-219096 is an Appointments rule.

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Reading the Rules Table

Two tabs sit above the table. All Rules shows every rule at your practice for the selected engine, with a running count, and Active Rules narrows the list to the ones currently in effect. Here is what each column tells you:

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Adjusting Your View

Open Display to reshape the table around how you work. It gives you four controls:

• Board or List switches between a column board and the standard table.
• Ordering sorts the table by a property such as Priority, and the button beside it flips between ascending and descending.
• Grouping breaks the list into sections by a property, or leaves it flat with None.
• Display Properties turns individual columns on and off.

Turn off the columns you do not need so the table stays readable: Group rules to break a long list into sections you can scan: Filter so the table shows only the rules you care about:

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Searching for a Rule

Click the magnifying glass to search. You can find a rule two ways: by its ID, or by its name.

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Inside a Rule

Click any row to open the rule. The Controls panel on the left holds four sections: Conditions and actions are laid out as a Structure you can read top to bottom:

• Trigger states the moment the engine runs, for example “a claim is generated or verified for submission.”
• Conditions: When gives the plain-language test, then the underlying logic as nested ALL and ANY groups of individual conditions.
• Actions: Then gives the plain-language outcome, then the specific action the rule applies.

An AI Generated badge marks any summary written from the rule’s logic. It is there so a condition built out of regular expressions still reads as a sentence. The precise logic always sits directly beneath it.

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The Properties Panel

The Properties panel on the right shows the rule’s current settings at a glance.

• Priority and Type are the same values shown in the table.
• State is the rule’s review status, for example Passed.
• Rule Status is whether the rule is Active or Inactive.
• Rollout Cap shows how much of your volume a rule currently touches, or Fully Released once it applies to everything.
• Last Updated shows when the rule last changed and who changed it.

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Comparing Versions

The dropdown beside the rule ID in the breadcrumb lists every version of the rule. Use it to compare what changed between versions and to confirm which version is the one running today. The same version links also appear in the Activity section.

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Editing a Rule

Prerequisite: You need edit permissions for the site or the rule engine the rule belongs to. To change an existing rule:

1. Open the rule from the Rules table.
2. Click Edit. The rule opens as Draft an update to Rule, followed by its ID.
3. Update what you need:
   • General holds State, Priority, and the Active toggle. Rule ID and Rule Type are fixed and cannot be changed here.
   • Description holds Reason for rule and Explanation of rule. Both are required, so a rule always explains itself to whoever reads it next.
   • Conditions and Actions hold the logic itself.
4. Click Save.

Note: Use JSON to view or paste the rule’s conditions and actions directly, instead of setting each field one at a time.

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Dry Running a Rule Before It Goes Live

A dry run replays a rule against real records and shows you exactly what it would have done. To dry run a rule:

1. Open the rule and click Dry Run.
2. Choose your scope:
   • Only This Rule tests the rule on its own, so you see its conditions and its changes in isolation.
   • All [Rule Type] Rules, for example All Submission Blocking Rules, tests your draft alongside every other active rule in the same category, so you can see how it interacts with rules that are already live.
3. In Controls, open the entity tab that matches the rule type, such as Claim Submissions IDs for a billing rule or Encounters IDs for an adjustment rule. Search for the records you want to test against and add them with +.
4. Click Continue.

Testing a single rule shows you the conditions that matched, the action it took, and the exact fields it changed: Testing against every rule in the category adds a Rules list, so you can see your draft in the context of the rules already running:

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Reading Dry Run Results

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Comparing the Claim Form

Once the dry run finishes, click View CMS Form in the top right to open a CMS 1500 Comparison. Before and After sit side by side, so you can confirm the rule changed the boxes you expected and nothing else.

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Related Guides

• Create a Rule covers building a new rule with AI, by cloning an existing one, or field by field.
• Working a Claim: Context & Activity Feed covers dry running billing rules from an individual claim before you submit it.
• The Billing Rules Engine covers the older engine-specific view of billing rules.

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FAQ

In what order do my rules run?

Rules run in ascending priority order within the same rule type. A rule with no priority set runs first, then priority 0, then 1, then 2, and so on.Note: Sorting the table by PRI changes only how the list is displayed. It does not change the order rules actually run in.

What is the difference between a rule and an automation?

An automation is an end-to-end pipeline: something triggers it, it runs a series of steps, and it produces an outcome. A rule is one self-contained decision inside that pipeline, in the form of “if these conditions are true, take these actions.”A rule engine is what groups and runs rules. The Rules tab lets you manage the individual rules underneath every engine in one place, rather than opening a separate screen for each.

A rule says Passed but nothing is happening. Why?

State and Status are two different things. State tells you the rule cleared review, so Passed means it is valid. Status tells you whether it is running, so a rule that is Passed but Inactive is approved and switched off.Check Rule Status in the Properties panel, and check Rollout Cap too: a rule on a phased rollout only touches part of your volume until it reads Fully Released.

Does a dry run affect real claims?

No. A dry run replays the rule against records you choose and reports what it would have done. Nothing is saved, submitted, or posted, and the records you test against are left untouched.

How do I tell which version of a rule is live?

Open the dropdown beside the rule ID in the breadcrumb to list every version, or open the Activity section for the full history with a version link on each change. Together they show who changed what, when, and which version is in effect now.