You must have Administrator rights to perform this task.

This help topic describes functionality that may not be part of the feature set in use at your company.

 

Add Compliance Rule

A Payer is an insurance company or a benefits manager responsible for reimbursement. The Add Compliance Rule feature allows Administrators to add compliance rules to the system regarding payer reimbursements.

Warning: Care Orchestrator is not a substitute for direct patient monitoring.

Note: Users can only add new Compliance rules to the system. Existing Health and Usage rules can be updated in the system, but new rules cannot be added for these rule types.

Note:  Health and Usage rules can be enabled and disabled at the organization level.  Rules should be customized to meet the needs of your location.

Note: There is no direct association between a Payer and Compliance Rule. For example, a patient can have a Compliance Rule selected, but no Payer assigned.

Note: Health, Usage, and Compliance Rules do not apply to EverFlo oxygen data.

See Compliance Determination for more information about compliance.

To add a compliance rule:

1. Click the Administration tab.
   Administration displays.

2. With the Settings tab selected, click on the Rules and Reminders rules tab. Click Compliance to display compliance rules.
   Available Compliance Rules display.

3. Click the Duplicate button located at the right of a Compliance rule.  
   
   Note: Choosing a rule that is closest to your desired rule will require you to make fewer changes. Trilogy Compliance Rules apply to Trilogy Evo devices.
   
   New Compliance rule is added that is a copy of the selected rule.

4. Update the Compliance rule information. Select the desired When value and activate the desired Then check boxes in the rule statement.  Update them as needed. Select the priority for the rule.
   
   Note: Make sure to name the Compliance rule so that all users can identify it in the system.
   
   Note: When rules are satisfied in Care Orchestrator, they trigger actions. For example, a task to follow up with the patient is added when certain rules are satisfied.

Note: Administrators can trigger an optional repeat clause for enhanced compliance evaluation. To repeat compliance evaluation and remind clinical users, physicians and other users every 30 days, select 30 for Repeat compliance evaluation every 30 days. This number can be changed by administrators at any time.

Note: Administrators can specify which date will be used as Day 1 of the start of the compliance period. Administrators can specify either First Therapy Date, Date of First Device Assignment, or Setup Date.

Note:  When the  assigned compliance rule has a start date of Setup Date and the setup date is modified the compliance status shall be reset and recalculated based on the new setup date.  

Note: If a patient becomes compliant within 30 days of the start of the compliance period, the system marks the patient as compliant after the 30-day mark, when the next therapy download occurs. The 30-day time period is configurable, and is provided as an example.

Note: If the Auto-dismiss all Patient Not Compliant tasks, when patient becomes complaint option is checked, then Auto-dismissed tasks are logged in the Patient Activity Log with a notation of auto-dismissed due to compliance achieved.

5. Click the Save button to add the new Compliance rule to the system.

 

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