Payer Rules: Bundling

The Bundling payer rule allows billers to combine specific services into weekly bundles. The rule also allows users to define minimum required hours and services that must be met before the bundle code is applied, and to create exceptions.

Required Permissions: You must be a Super Admin to add and edit payer and billing rules.

Creating a Billing Rule

Before you begin, you must create a payer rule. For detailed instructions, click here.

1. Once you've created a payer rule, click Add Billing Rule.
2. Select Bundling from the Billing Rule Type drop-down. This field is required.
3. Next, choose the code (or codes) that should initiate the bundle. You can select one or more codes, as needed. This field is required.
4. Select the billing week that best fits your needs from the Billing Week drop-down.
   1. Note: Date of Service and Date of Service Through will match the first and last day of the week as chosen here.
5. If needed, enter the minimum number of services that must be included before the bundle code is applied.
6. Then, if necessary, add the minimum number of hours that must be met before the bundle code is applied.
7. Next, select the code that should be included in the bundle. This field is required.
8. Bundle codes will only be applied if all the requirements are met, unless you create an exception. To do so, select the Unmet Exception Bundling checkbox.
9. In the Weekly Bundle Allowance field you can add a weekly bundle allowance. Weekly bundle allowances are uncommon, but will allow users to bypass the bundle requirements a number of times equal to this number. Once bundles have been created ignoring the minimums a number of times equal to the number entered in this field, no more allowances will be be permitted until a bundle is created that meets the minimums.
10. Click Update to save your payer rule.