This is the engine room. The rules engine encodes your billing logic once so it applies to every claim
automatically, and the claims workspace is where your team works everything the rules could not finish
on their own. Rules are yours to author, test, and roll back.Beta. In product and working, but ask your Athelas team to turn it on.
A human-readable summary sits next to each rule. AI explains even regex-heavy conditions, and internal IDs resolve to real payer, provider, and patient names.
A before-and-after comparison of what the rule would have changed. One rule at a time.
New-rule safety sampling
An automatic platform safeguard: new rules apply to a limited sample of claims first, then expand once performance is confirmed. Applies to billing rules and auto write-off rules alike, and sampling progress is visible in product.
Build and validate a claim without sending it. See which rules would fire, which pre-submission blocks apply, and any field-level clearinghouse errors, then fix them in product.
Verified, then transmitted: rule validation plus clearinghouse verification, with the route auto-selected per payer. Failures come back in plain language and auto-open a fix-it task in the Rejections worklist, so every submission error surfaces in one place.
Every insurance name in your EHR mapped to one payer record, so claims route to the destination that payer expects. Unmapped names are listed with the patient, encounter, and appointment volume behind each one, and recommended matches are suggested as you map.
One unified worklist for every claim, with rejections, denials, and claim details in one place. Advanced filters and saved views per user, optional columns, hotkeys, simplified statuses, time-in-status sorting, group-by-reason, a unified assignee view, and CSV export.
Assign claims to individual billers and group a worklist by owner, reason, or payer, so each person works their own list. Assign on a single claim or across a bulk selection, and the assignee shows on the row without opening the claim.
Defer a claim with a reason to capture actions taken outside Insights. Powers auto-deferral of recently submitted claims and pauses previously generated patient responsibility on resubmission.
Submissions, remittances, payments, attachments, and the claim’s status reason side by side on one screen: the full picture needed to make a call, without hunting across pages. Actions sit in the same place on every claim, so the hundredth works like the first.
On drug claims, the correct National Drug Code, units, and drug details are filled in automatically from your preferred products. Billers can override through a searchable autocomplete.
EHR integration & data sync
Pulls appointments, encounters, charges, medical records, and patient files from your existing EHR on a schedule, with payer-specific fixes applied for modifiers, NDC, CLIA, and value codes. 50+ supported EHRs. Set up by Athelas at onboarding.
