Rules
Rules are how ClaimPod decides what a person needs to look at. They are the difference between reviewing every claim and reviewing the few that a rule stopped.
A Rule Reads as When This, Then That
Section titled “A Rule Reads as When This, Then That”Each rule pairs a condition with an outcome, and fires at a named point in the workflow. A claim review rule runs when a claim is checked. A remittance rule runs when a remittance arrives. The rule decides whether what it found is worth a person’s attention, and how loudly.
Findings Have Weight
Section titled “Findings Have Weight”Not every finding stops a claim. Some block it outright, and some are advisory: worth reading, not worth halting for. This is what lets a clean claim promote itself to Ready without anyone opening it, while a genuinely questionable one waits.
Rules Are Data, Not Code
Section titled “Rules Are Data, Not Code”Rules live in the client’s configuration rather than in the product, so they can be changed for one client without changing anyone else’s. A rule that does not suit a client is switched off rather than deleted, which keeps its history and lets it come back.
When a Change Takes Effect
Section titled “When a Change Takes Effect”For most triggers a rule change applies from the next evaluation: the next import, readiness check or statement. Claim Review is the exception, because a claim waiting to be sent should be judged by the rules it will go out under. Creating an active Claim Review rule, a save that changes what one decides, deleting an active one, applying a library update to it, and activating, deactivating or deleting several at once all start a re-check of every Draft and Ready claim. A rename or a priority change does not.
The re-check only judges. A Ready claim that now has a blocking finding goes back to Draft, a Draft claim’s findings are refreshed, and nothing moves forward on its own. A Ready claim held by an export batch is left as it is.
Claims already sent are never re-judged, and their findings are not rewritten. That is deliberate: a finding on a sent claim records what was true when it went out, and quietly rewriting history would make the audit trail useless.
Related: Rules · The Claim Loop · Check and Fix a Claim