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

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

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

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.

Changes Are Not Retroactive

A rule change applies from the next evaluation. Existing findings are not rewritten, and claims already reviewed are not re-judged. If you need a claim re-evaluated under a changed rule, check it again.

That is deliberate: a finding records what was true when someone looked, and quietly rewriting history would make the audit trail useless.

Related: Rules · The Claim Loop · Check and Fix a Claim