alloFactor: Medical Practice Scheduler, Billing, EMR Software & Patient portal


Rules Engine

Rules engine is your surest way to get high first claim pass rates. Rules engines are built into alloFactor with a standard set of rules to prevent bad claims from getting submitted to payer. You can even add payer, provider, or state specific rules for your own clinic.
Default rules alloFactor comes with a predefined set of rules to virtually eliminate rejections and denials. Default rules validates that all fields are filled out appropriately. It checks for mandatory fields and data formats within the fields.
Rule management New custom rules can be added or edited through the Administration module. For each rule, user can specify the level (error or warning) and description.
Error flagging Claims are validated against these rules on electronic claim submission. Upon submission alloFactor instantly verifies and marks the claim as rejected. User can then view details of the rejection and correct and resubmit the claim immediately.
Custom rules You can setup your own custom rules to your individual clinics needs. You can setup general rules that applies to all claims or categorize rules that only apply to certain payers, states or providers. Each rule may be checking for or defaulting to certain value and can bet setup as errors or warnings. The rules can be set for any of the fields in the CMS1500 form.