The Rule Workspace

Where a rule is authored. The same surface serves a new rule and an existing one, so New rule and opening one from the library land in the same place.

Who Can See It

Administrator only, when the client is licensed for rules. Other roles can open a rule and read it, but the workspace tells them it is read-only.

The Tabs

Tab	What it holds
Overview	The rule’s settings and its flow
Activity	What this rule has done. Only on a rule that exists. When reads as a relative time; hover it for the full timestamp

Settings

Field	What it decides
Name	What the rule is called in the library and in findings
Active	Whether it runs at all
Priority	The order it runs in against other rules on the same trigger
Effective From, Effective To	The window it applies in. Both ends count: a rule effective to 09/30 still fires on 09/30

The window is judged by the day a record is checked, not its date of service. To make a Claim Review rule cover services from a date on, add the condition Service date in a policy window instead. Leave Effective To empty to run with no end. A date before the from date is refused with Must be on or after the from date. The window is read against your practice time zone, so a rule starts and stops on your calendar day rather than the server’s.

The Flow

A rule reads in three parts: When names the trigger, If lists the conditions, and Then the outcomes. Pick the trigger first - until one is chosen the conditions and outcomes stay locked, because what a rule can ask about depends on the moment it runs.

The If row carries its own matcher: whether all of the conditions must hold, or any one of them.

Conditions describe what must be true. Outcomes are what happens when it is - usually a finding on a field, sometimes routing the record to a queue. A CPT or ICD-10 code list takes codes one at a time or a pasted list. Procedure billed without an accepted diagnosis pairs a CPT code list with the ICD-10 codes that justify it.

Rules From the Library

A rule installed from the ClaimPod library says so in its header, with the version installed. Compare with Library, in the rule’s menu, shows what has changed upstream since, so a local edit is never silently overwritten and an upstream improvement is never missed. While a newer version is waiting, the header also offers Review Update.

The comparison ends on a choice. On a waiting update, Keep Mine keeps your version and stops offering that update, and Apply Update takes the library version; on a rule you have edited it asks first, because your edits are discarded. On a rule you have changed with no update waiting, Revert to Library puts the library version back, after asking. If the rule changed since you opened the comparison, the choice is refused with Reload.

Actions

Action	What it does	When it is offered	When it is offered but greyed
Save	Stores the change. Changes show a save bar with Save and Cancel, and Cancel asks Discard Changes? On a Claim Review rule, a save that changes what the rule decides also re-checks open claims, below	On an existing rule	-
Create Rule	Stores a new rule. An active Claim Review rule also re-checks open claims	On a new rule	-
Test Rule	Runs it against real records without saving	When your account also holds the User role, or is a Superadmin. On a wide screen it is a panel beside the rule rather than a button	Until a trigger is picked and at least one condition exists
Review Update	Opens the comparison with the newer library version	On a library rule while an update is waiting	-
Compare with Library	Shows what changed upstream since it was installed	On a library rule with no update waiting	-
Duplicate	Starts a new rule from this one	On an existing rule, for an Administrator	-
View History	Shows what changed and when	On an existing rule	-
Delete	Removes the rule	On an existing rule, for an Administrator	-

Compare with Library, Duplicate, View History and Delete sit in the rule’s menu, with Delete last.

On a Claim Review rule, creating it active, a save that changes its conditions, outcomes, window or active switch, and deleting it while active each start a re-check of every Draft and Ready claim. A rename or a priority change does not. The toast reads Rule saved or Rule created with, for example, “Re-checking 42 open claims (draft and ready).”, and offers View Run to a User. What the re-check does is on Rules.

Test Rule is the safe way to answer “what would this have done”, because it never writes a finding. It runs your current edits, saved or not. Search for any record in the client and select Test Run, or select Check Recent to test the most recent records at once and see which ones the rule fires on. On a wide screen the test sits in a Test Rule panel beside the rule, picking a record there runs the test at once, and the record you test against also marks each condition in the flow as matched or not. Changing the trigger clears the panel, since a record picked for one trigger does not fit another. A Coding Review rule is tested against a visit. Statement Generated rules can’t be traced against a record yet, and the panel says so.

If someone else saved the rule after you opened it, the save bar shows Reload in place of Save, which drops your edits; see A Save Was Refused.

States

• Pick a trigger to unlock conditions and outcomes on a new rule.
• Pick a trigger to test this rule against a record. in the Test Rule panel of a new rule, until a trigger is picked.
• Read-only for your role - a non-administrator sees the rule and a note that an Administrator can edit it.
• This rule isn’t in this client if you follow a link scoped elsewhere, or the rule was deleted - with a way back to the library.
• Couldn’t load this rule with a Retry when the request itself failed. A rule that is merely unreachable is never reported as deleted.
• Blocked - without the rules module the screen is not in the sidebar, and a saved link to it says the module is not part of your plan.

Related: Rules · How Rules Work