Which rules can be used to send charges to the alternate payer?

Which rules can be used to send charges to the alternate payer?

• A. Data rule or fee rule
• B. Account rule or charge rule
• C. Payment rule or adjust rule
• D. Coverage rule or edit rule

Answer: (B)

Routing charges to an alternate payer relies on rules that determine payer assignment and how charges are posted. An account rule sets or enforces which payer is linked to a patient’s balance or encounter, including directing it toward an alternate payer when appropriate. A charge rule directly controls how individual charges are posted to payer lines, and can specify that certain charges should go to the alternate payer instead of the primary one. Together, these rules let you route specific charges to the alternate payer during posting. Other rule types govern different areas—data validation, fee calculation, how payments are applied, adjustments, coverage details, or edits—and they do not by themselves determine to which payer charges are sent. So for directing charges to an alternate payer, account rules and charge rules are the applicable tools.

Routing charges to an alternate payer relies on rules that determine payer assignment and how charges are posted. An account rule sets or enforces which payer is linked to a patient’s balance or encounter, including directing it toward an alternate payer when appropriate. A charge rule directly controls how individual charges are posted to payer lines, and can specify that certain charges should go to the alternate payer instead of the primary one. Together, these rules let you route specific charges to the alternate payer during posting.

Other rule types govern different areas—data validation, fee calculation, how payments are applied, adjustments, coverage details, or edits—and they do not by themselves determine to which payer charges are sent. So for directing charges to an alternate payer, account rules and charge rules are the applicable tools.