At a Glance
Suggested PR Rules save your staff time by automatically recommending what to collect (copay, coinsurance, deductible, etc.) based on criteria you define, so they don’t have to look up fee schedules and benefits by hand.How to Set a Suggested PR Rule
Go to the Suggested PR Rules tab in PR Settings and click Add Rule.- Give the rule a Name and a Priority. (You can also set an optional End date after which the rule stops applying.)
- In the Actions block, click Add Action and choose what the rule should do — for example, Set Copay Amount in USD Cents (enter
1000for $10), then Add Action again to Prioritize Family Deductible. - In the Conditions block, add the conditions that must be met. Choose All or Any, then add single- or multi-statement conditions. Each statement is a Variable / Operator / Value — for example, Patient Age ≥ 65 and Appointment Type = Diagnostic X-Ray.
- Click Save. The rule appears in the Rules list, where you can edit, copy, or archive it.
Priority determines overrides: rules with higher priority values override rules with lower priority values. For example, a Priority 2 rule overrides a Priority 1 rule. (Global rules can’t be edited — create a specific higher-priority rule to override one.)
Where Suggestions Appear
Suggested PR Rules don’t preview in Settings — they surface at check-in:- In the eligibility result, a Suggested PR Rules Applied section lists each applied rule (the highest-priority rule first).
- In the payment flow, a Suggested Charges alert shows the recommended copay/coinsurance/deductible/self-pay amounts.
Actions Reference
Conditions include appointment reason/type, facility, patient age or date of birth, QMB status, and primary/secondary insurance details (payer, company type, member ID, plan/group), as well as remaining deductible and out-of-pocket amounts. If you need options beyond these, contact your account manager.
FAQ
Two rules conflict — which one wins?
Two rules conflict — which one wins?
The rule with the higher priority value wins. For example, a Priority 2 rule overrides a Priority 1 rule.
Where do I see the suggested amount?
Where do I see the suggested amount?
At check-in — in the eligibility result’s Suggested PR Rules Applied section and the payment flow’s Suggested Charges alert. There is no preview inside PR Settings.