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Advanced Workflow Rules Engine (OP AWARE) Overview

Version 20.5
Path: Billing tab > More button (Customize group) > Advanced Workflow Rules

Overview

The Advanced Workflow Rules Engine (OP AWARE) is a tool used to build billing rules based on specific criteria. The functionality is similar to that of the former Block and Substitute feature, but OP AWARE provides an expanded list of superbill details and actions to build rules around. Some of the benefits of this expanded rule building include the opportunity to leverage Billing Groups and the ability to manage the complexity of CPT Code (or Group) occurrence and concurrency when a combination of superbill elements apply, without manual intervention from the billing staff. The window is displayed in two sections: Triggers and Actions.

Note: Previously created rules in the Block and Substitute window are automatically populated in the OP AWARE rule table. It is not necessary to recreate rules that were already established for your practice.

Both sections of the window must be completed to successfully build and apply the rule.

Triggers (the "When")
Actions
This section tells the story of when to trigger the rule. The criteria set here tells OP what to look for on a superbill when applying the rule at the time of superbill conversion. Click here to learn how to define Triggers. After defining the Triggers, you must complete the Action.
This section tells OP what to  do with superbills for which the triggers have been met. There are seven Action options to choose from, and each option presents a different set of fields that may be completed. Click here to learn how to select the Action.