Rule Tester:
It is important to verify the validity of the rules created. By running the Rule Tester for the various services or inventory items you sell, the rule tester will provide a list of each rule applied or if a conflict exist between rules created, Filopto will report in the tester that the selected rule is in conflict. It is extremely important that you test the rules you create for accuracy. If you instruct Filopto via a rule to do the wrong action, it will execute this incorrect rule and cause your claim to be inaccurate.
|
How to test a Rule
Select the item/service (2) you which to test the rules against. If a rule is date specific make certain the date falls within the parameters you are testing. Place a quantity of 1 to test for 1 item. Select the office (rules can be office specific) and then press the Test Rules button(3)
In the above example, we are testing against the following rules. Note that in this example 2 rules are applicable for the item selected.
When executing the Test Rules (3) button the following results are calculated and displayed.
Eligibility Rules:
Annual Fee:
The following eligibility rule will be displayed at:
- Appointment Time
- Invoice Time
The Patient has an applicable annual fee of $ 10.50.
Billing Rules:
Item's Type: FRAME
Item's Description: L5106 (3420)
Item's Procedure Code :
Item's Procedure Code Modifier No.1:
Item's Procedure Code Modifier No.2:
Item's Procedure Code Modifier No.3:
Item's Category: Ricardo
Item's Group:
Retail Price: $ 135.00
Wholesale Price: $ 65.00
Policy Pays: $ 55.00.
-Patient co-pay notes:
Patient Co-Pays the Balance Amount: $ 80.00
Balance Amount: $0.00
Rule Conflicts:
When rules conflict with one another the Rule Tester will display in it's report information that can be used to correct the error(s). In the example below the rule tester identifies by name the rule number 67 (Name of rule: Exam) and rule number 139 (Name of rule: error policy) are in conflict. If the conflict is not resolved the Filopto engine will not be able to determine which rule to apply and will arbitrarily apply one of the rules in conflict which may result in an incorrect claims being sent to the insurance company.
Eligibility Rules:
Annual Fee:
The following eligibility rule will be displayed at: - Appointment Time - Invoice Time
The Patient has an applicable annual fee of $ 10.50.
Billing Rules: Item's Type: SERVICE Item's Description: Comprehensive Eye Examination - New Patient Item's Procedure Code : 92004 Item's Procedure Code Modifier No.1: Item's Procedure Code Modifier No.2: Item's Procedure Code Modifier No.3: Item's Category: Exam Item's Group: Retail Price: $ 130.00 Wholesale Price: $ 0.00
There are more than one rule for Policy Pays for the selected inventory item type. This causes a conflict. We cannot determine which rule will be applied. List of conflicting rules: - 67, Exam - 139, error policy
-Patient co-pay notes:
Patient Co-Pays the Balance Amount: $ 130.00
Balance Amount: $0.00
|
