What’s changing
We’re introducing a Billing Rules Engine that lets portal administrators control how billing codes are generated for each program. Instead of relying solely on the system’s default, portal-level rules will determine code generation going forward. This release exposes the current default rules in the portal; the ability to create and edit custom rules will be available in a subsequent release.
Why this matters
Gives portals flexibility to align code generation with your workflows and program-level requirements.
Improves audit readiness by making the code-generation logic explicit and centralized.
Preserves historical integrity by keeping past reports unchanged while new rules govern future billing cycles.
How it works
A new “Billing Rules Engine” entry appears under Settings.
Program view: Clicking it shows all programs active for your portal, and the current rule set applied to each.
Current release: You will see the existing default/global rules as they are implemented today.
Future release: You will be able to create program-specific custom rules. Until you create custom rules, the system will follow the Global Rules.
Active billing months: CPT codes continue to be generated as they do today for the current (active) billing month. Changes you make in the Rules Engine will affect billing logic only for future billing periods after those changes are applied.
Example
99490 today: The 99490 code is produced by default regardless of Interactive Communication (IC) status.
With a custom rule (future release): You could require IC to be enabled before 99490 is generated for a program, so the code is only produced when that condition is met.
Benefits
Greater control: Define program-level rules, so codes are generated exactly as your workflows require (available when custom rules rollout).
Consistent, auditable logic: Centralized rules make it easier to document and defend code-generation decisions during audits.
Reduced reconciliation: When custom rules are used, billing teams spend less time reconciling expected vs. generated codes because the code generation logic is explicit and configurable.
Preserved historical accuracy: Historical billing reports remain unchanged and continue to reflect the billing logic that was in place when those periods closed.
Frequently asked questions
Q: Can I see historical billing reports after this change?
A: Yes. Historical reports remain accessible for download and review.
Q: Can historical reports be edited after a month is finalized?
A: No. Once a month is finalized, that report is a locked snapshot and cannot be modified.
Q: If I update rules, will that change past billing results?
A: No. Rule updates only affect billing generation for periods after the change takes effect. Past billing periods remain unchanged.
Q: When can I create or edit custom rules?
A: This release surfaces the current global rules in the portal. The interface to create and edit custom rules for each program will be available in a subsequent release; we will share timelines and release notes when that capability is ready.
Q: Will CPT codes still be generated the same way today for the active month?
A: Yes. CPT codes for the active billing month continue to be generated as they are now. New rule settings will apply to future periods.
Q: What happens if I don’t create any custom rules?
A: The system will continue to follow the Global Rules by default.
Q: Who should I contact for help or to request custom rule support?
A: Please contact your account manager or our support team via the portal Support link for guidance, implementation assistance, or to request help crafting rules when the edit capability is released.
Thank You