Billing Audit Tool: Payer Rules

Creating a Payer Rule

Super Admins can create Payer Rules for one or more locations within your instance.

Next, open Payer Rules.
From the landing page, you can view, edit, delete, copy, enable, or disable all existing payer rules. You can use the Location drop-down to view payer rules tied to a specific location.

Edit: Click on the Edit icon to edit an already existing rule.
Copy: Click on the copy icon to create a duplicate of an existing rule.
Delete: Click on the red x to delete the rule. You will be prompted to confirm the deletion.

To add a new payer rule, click on the + Add Item button.
Complete the Create New Payer Rule form. Required fields are marked with an asterisk (*).
Enter the name of your rule in the Payer Rule Name field. This field supports a large amount of text, so this name can be as long as needed.
You can add a short description and a long description in the appropriate fields, as desired.
Search for the desired Payer. Kipu RCM integrated payers appear with an [AO-] prefix. You can only create a rule for one payer at a time. If you need to have the same rule available for multiple payers, you must create a copy for each one.
The Payer Internal ID and Payer External ID fields will automatically populate based on your selection.
Next, set the rule's start date by clicking on the Start Date field and choosing a date from the calendar or manually typing in the date. The rule will not apply to dates of service before the Start Date.

The End Date field is optional and can be used to provide a date after which the rule will no longer be applied to matching charges.
Be sure to enable your rule by checking the Enabled box. If you do not enable the rule, it will not be applied to the billing audit tool report.
Select the desired location (or locations) that will use this rule.
Click Create to begin defining the related Billing Rules.