Apply Rule to Payer(s)

The Apply Rule to Payer(s) screen allows you to create or edit the rules that will assign claims and/or send a system alert to a specific user or group when the claim enters a specific threshold. A Claim Note is added when claims are assigned based on these rules.

This screen is accessed by clicking New or Edit from the Timely Filing Payer Rules screen.

Modifying Payer Rules

Enter (or update) Payer Rule information as follows. Note that the Payer Summary section is blank until Payers have been assigned to the rule.

Select a predefined threshold in the Select Threshold drop-down list. This list displays only the Active thresholds.
Enter a unique name for the rule into the Rule Name field.
In the Group/User Assignment section, select the Group and User that will receive the claims associated with this rule. To assign claims randomly to all available members in a Group, select None in the User list.

Note: Groups or Users not scheduled to receive claims (or Groups that do not contain any users scheduled to receive claims) will not appear in the Group and User lists.
Select the Send Alert option if the claim owner should receive a system alert based on this rule.
Complete the desired fields in the Payer Search Criteria section and click Search. Results are displayed in the Search Results section.
In the Search Results section, click the box in the Select column next to the Payer(s) to which the rule should be applied. Click the Select All button to select all Payers.
Click Save to apply the rule to the selected Payer(s). The Payers will display in the Payer Summary section of the screen.
Click Close to return to the Timely Filing Payer Rules screen.

Remove Payers from a Rule

Select a rule from the Timely Filing Payer Rules screen.

Click Edit. The Apply Rule to Payer(s) screen opens. Payers currently assigned to the rule are displayed in the Payer Summary section.
To remove a payer shown in the Payer Summary section, right-click on their name in the grid and select Remove.
To find and remove specific payers:
- Enter criteria into the Payer Search Criteria section. Payers that are assigned to the rule selected in Step 1 are identified with the Select column.
- Clear the Select column check box for the payer(s) you wish to remove.
- Click Apply.
Click Save to commit changes.
Click Close to return to the Timely Filing Payer Rules screen.