Billing Audit Tool: Payer Rules Overview

The Payer Rules tab under Settings > Billing Audit Tool allows you to create billing rules specific to each payer.

Required Permissions: You must be a Super Admin to view or make changes to payer rules.

1. To begin, click on your initials and then click Settings. 
   
2. Then click the Billing Audit Tool tab.

3. Next, open the Payer Rules tab.

Creating Payer Rules

Check out the following instructions for creating a payer rule.

Important: If you are creating payer rules for the Kipu RCM, be sure to select a payer that starts with AO-.

Creating Billing Rules

Once you create a payer rule, you can add a billing rule.

• Add Modifier
• Admit to Discharge
• Bundling
• Case Management (Beta)
• Do Not Bill
• Drop Diagnosis Codes
• Funding Source - Coming Soon
  • For customers using the Kipu RCM Integration, this rule is only required if specifically requested by a payer. To configure Funding Source fields in the RCM, please contact their support team at [e-mail]. 
• MAT Dosing
• Office Based MAT
• Present on Admission
• Replace
• Replace Place of Service
• Service Review
• Unit Billing