VIII: Creating Custom Rules Using the Rule Editor

Question 1

What do rules do?

Answer 1

Rules define what scenarios we want the system to find. It doesn’t define when we want the system to look or the functions to perform when those scenarios are found.

Question 2

What is a criterion?

Answer 2

Property, Operator and Value (Item = Value).

Question 3

What is recommended when creating a rule for procedures? Procedure property or CPT?

Answer 3

CPT

Question 4

What buttons do you click in order to find the item number and INI of a field in PB Charge Entry?

Answer 4

Ctrl + Click

Question 5

In Text, how sould you find the “address” of the field you are looking for (INI and Item #)

Answer 5

Home + F8

Question 6

Service date vs Day Properties

Answer 6

Service Date T-7, Days use greater than

Question 7

What does “context” define

Answer 7

Context defines where rules can be used and determines the properties that will be available.

Question 8

What is a “property”

Answer 8

An item in the system to search for

Question 9

What is an “operator”

Answer 9

relationship between properties and values (=, <>, >, <)

Question 10

What is a “value”

Answer 10

A response to a property

Question 11

In the rule editor, how can you search with INI and Item Number?

Answer 11

Click on the arrows next to the search button for more search options.

Question 12

If the rule you are building needs to catch procedures with any modifier what operator can you use?

Answer 12

Use the “does not equal” operator and leave the value blank.

Question 13

How would you look up items in Text that you might want to use in rules?

Answer 13

Navigate to the field and type HOME+F8

Question 14

If the Raw data field shows and ID number, what does this mean?

Answer 14

Then the system is actually storing a pointer to a different masterfile.

Question 15

If the Raw data field shows the exact same thing that displays in the field, what does this mean?

Answer 15

Then the system is storing the free text typed as a string of text.

Question 16

To catch part of a string of free text in a rule, what can you use?

Answer 16

The operator “String-Contain”

Question 17

What issue/s can arise when using the “string-contain” operator?

Answer 17

It will identify the value even if it’s part of a longer value. For example if you are looking for modifier 26, it will also find 260, 126 or anything with 26 in it.

Question 18

To avoid “string-contain” issues, what property can you use to find the exact match?

Answer 18

Select the more specific “item” under that property.

Question 19

If you would like to see a definition of each operator, how would you access this?

Answer 19

F1

Question 20

What is the system functionality of a PB Visit Context?

Answer 20

Visit Filing Order Review/Retroadjudication

Question 21

What is the system functionality of a Universal Charge Line

Answer 21

Charge Router Charge Entry Validation Messages

Question 22

True or False: A rule can contain more than one criterion

Answer 22

True

Question 23

What are the three types of evaluation logic to determine the relationship between criterion?

Answer 23

And (must meet all criteria), or (must meet any one criterion) and custom (define and and or relationships between multiple criteria)

Question 24

True or False: You are unable to accept a rule without entering a message.

Answer 24

True.

Question 25

How do you create a dynamic error message such as CHARGE SESSION»Account»Acct Type?

Answer 25

Click insert and use the property tree. Any additional comments to describe the error a charge qualifies for should appear inside the quotation marks

Question 26

What is the configuration of the “Day” Property when creating a rule?

Answer 26

This property references a specific date in the past and count forward. e.g. You can enter the number of days in the value field

Question 27

What is the configuration of the “Date” property when creating a rule?

Answer 27

This is when you use T-1 or T. Day 1 in the system is 1/1/1841.

Question 28

For the Date Property, which Operator(s) are used? and what is the Value?

Answer 28

< or <= Value is T-x

Question 29

For the Day Property, which Operator(s) are used? and what is the value?

Answer 29

> or >= Value is number of days.