Path: Billing tab > More button (Customize group) > Advanced Workflow Rules
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. The Trigger (or the "when") tells OP what data to look for on a superbill. When the specified elements are found, the defined Action will be applied. At the bottom of this page, click to continue to the Action section once you have entered the Triggers for the rule.
Create a New Rule and Define Triggers (or the "When")
- Navigate to OP AWARE by following the path above.
- Click the Add button.
- Enter a unique name for the rule in the Rule Name field. This is required to save the rule.
- Confirm/enter the Start and End Date in the respective fields. The Start Date defaults to the current date. An End Date should only be entered if appropriate. If the rule will never expire, leave this field blank.
Note: After a rule has been saved, the End Date cannot be removed or extended if any of the associate Billing Groups have an Inactive status.
- Use the table below to complete the left-hand side of the window. Please note: All fields are optional, unless noted as required below.
This section gives the practice the ability to decide what CPT Code or Group will drive the rule that is being created. This is the first element OP will look for when applying the rule.
This section gives the practice the ability to further specify the CPT Code or Groups on a superbill. When a selection is made in both sections a and b, OP will look for a combination of two (or even three) CPT Codes or Groups.
|This section gives the practice the ability to align the rule for the appropriate payer(s). You can choose one of the three options or a combination, as follows: OP allows you to populate both the National Payer ID and Claim Filing Type fields to accommodate situations where a private payer manages Medicaid plans. That National Payer ID may have different rules for commercial claims than it does for Medicaid claims. If these fields are left blank, the rule will apply to all payers.|
|This section gives the practice the ability to take into consideration additional superbill details that should be looked at when OP applies this rule.|
|This section gives the practice the ability to enter the patient's age in days (d), weeks (w), months (m), or years (y) as it pertains to the application of the rule.|
|This section gives the practice the ability to narrow down the rule application to superbills that include a specified Place of Service.|
You have completed the triggers section of OP AWARE (or the "when").
To complete the building of the rule, continue to the OP AWARE Actions section >>