Advanced Workflow Engine (OP AWARE)

Billing Groups are created to group together sets of CPT or Diagnosis Codes, by range or list, to support the OP AWARE functionality.

The Advanced Workflow Rules Engine (OP AWARE) is a tool used to build billing rules based on specific criteria.

This section introduces a user to the OP AWARE fields available for creating the Triggers (or the "when") circumstances for which the rule will be applied.

After completing all of the applicable Triggers for the OP AWARE rule, the Actions section located on the right-side of the window must be completed in order to tell OP what to do with superbills that fit the criteria outlined for the rule.

This video shows how to create an OP AWARE Edit Rule to add a modifier to one CPT Code when it occurs on the same superbill as another CPT Code.

This video shows how to create an OP AWARE Rule to add a modifier to one CPT Code, and add an additional CPT Code with its own set of modifiers.

This video shows how to create an OP AWARE Remove Rule to remove a CPT Code when it occurs on superbills for a specific Payer.

This video shows how to create an OP AWARE Split Rule to split one superbill's charges into two separate claims, for two separate responsible parties, and Insurance Payer and SP.