🎟️ How to Create Suggested Charge Rules – Athelas

At a Glance

Creating Suggested Charge Rules can save your staff a lot of time on the administrative tasks related to appointments.

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Appointment Rules (can be set by your account manager) These can instantly apply the correct Service Type Codes (STCs) to certain kinds of appointments. They can also set particular appointments as primary care, based on your organization’s best practices.

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Suggested Charge Rules (formerly Pre-Visit Rules) These can determine things like suggested copay, coinsurance, the prioritization of deductible or copay, etc. based on criteria set by your organization.

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Both types of rules function based on Actions and Conditions set by you, the user. Actions are the specific steps that will be carried out based on the Conditions, or criteria, that you set.

Walkthrough: How to Set Suggested Charge Rules

Currently, you can set Suggested Charge Rules via the Suggested PR Rules tab in Patient Responsibility Settings. Click Add Rule.

Give your rule a name and optional level of priority. The higher the numerical value, the higher priority. For example, a rule with Priority 3 will override a conflicting rule of Priority 2

For this example, imagine you want a Suggested Charge Rule that will set a $10 copay, prioritize any remaining family deductible for patients over 65 years of age, and only apply when the appointment is for a Diagnostic X-Ray.

In the Actions block, choose to Set Copay Amount in USD Cents and enter 1000, to equal $10.

Then, click Add Action and select Prioritize Family Deductible.

Now, add the conditions that must be met to activate this rule.

Under Condition Type, choose All, so that all criteria must be met and not just one (as would be the case by choosing Any).

Under Variable, choose Patient Age and set it greater than 65.

Click Add Action

For this Variable, choose Appointment Reason and set it equal to 4 (the STC for Diagnostic X-Ray. Be sure to look up and enter the proper STC for your rule if you use this or a related variable).

Click Save. Now you can view your rule in the Rules list, and edit, copy or archive it from there.

Suggested Charge Rules: Actions and Conditions Reference List

Below is a list of all Actions and Conditions currently available for Suggested Charge Rules. If you would like more options, please contact your account manager.

Action	Definition
1. Copay Filter In	Pulls in the chosen text from the eligibility response to be displayed as a payment recommendation. Example: If the input text is PCP, then it will display the charge associated with the copay for PCP from the eligibility response on the appointment.
2. Copay Filter Out	Excludes the chosen text from the eligibility response so it is not displayed as a payment recommendation. Example: If the input text is PCP, then it will not display the charge associated with the copay for PCP from the eligibility response on the appointment.
3. Copay Filter Place of Service	Filters in the amount to be collected based on the input place of service. Example: If the input place of service is Hospital - Outpatient, then it will display the copay associated with Hospital – Outpatient from the eligibility response.
4. Find Limitations and Set Charges	Finds the input limitations from the eligibility response and defaults to the chosen charge Example: If the input limitation is for a maximum of 6 sessions and the chosen copay is $50 for anything above that, then it will display that charge as a suggested amount to be collected.
5. Notify	Leaves a message on the patient’s appointment for the front desk to read.
6. Prioritize Copay	Prioritizes copay to be collected over coinsurance or deductible.
7. Prioritize Family Deductible	Prioritizes the family deductible to be collected over coinsurance or copay.
8. Set Coinsurance Amount in USD Cents	Input a specific coinsurance amount to be collected.
9. Set Copay Amount in USD Cents	Input a specific copay amount to be collected.
10. Set Deductible Amount in USD Cents	Input a specific deductible amount to be collected.
11. Set Self-Pay Amount in USD Cents	Input a specific amount to be collected if patient is self-pay.

Conditions

Appointment Reason

Appointment Type

Coinsurance Percentage

Copay in USD Cents

Facility

Has QMB Insurance

Limitations Payer Notes

Patient Age

Patient Date of Birth

Primary Group Name

Primary Input Insurance Name

Primary Insurance Company Type

Primary Member ID

Primary Payer

Primary Payer Patient Is Dependent

Primary Plan Description

Remaining Deductible in USD Cents

Remaining Family Out of Pocket in USD Cents

Remaining Out of Pocket in USD Cents

Secondary Input Insurance Name

Secondary Insurance Company Type

Secondary Member ID

Secondary Payer

Further Assistance

📢 We’re here to help! Please contact your account manager if you would like help with all this.