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Documentation Index

Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt

Use this file to discover all available pages before exploring further.

This page lists and manages payer-specific modifier rules used for claim validation, accessible at the route /pm/payer-modifier-rules.

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Overview

The Payer Modifier Rules page is an admin interface for managing pm_payer_modifier_rules records, scoped to the current organization. Rules define how specific CPT modifier codes should behave for a given payer (allowed, required, forbidden, or warning) with a severity level (error or other). The table is filtered by effective date by default (expired rules are excluded unless includeExpired is set). A payer dropdown filter lets users narrow the list to a single payer. Users with pm.payer-modifier-rules.manage permission see a New Rule button. Each rule row has four inline actions: Edit (opens form dialog), History (opens version history dialog), Pause/Play (toggle active state), and Delete (soft-delete). Rules are sorted by modifier_code ascending.

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Who it’s for

Requires permission PM_PERMISSIONS.PAYER_MODIFIER_RULES_VIEW (pm.payer-modifier-rules.view), enforced via both RequirePermission in src/routes/pm.tsx and PermissionGate wrapping the page content. Creating, editing, and deleting rules additionally requires PM_PERMISSIONS.PAYER_MODIFIER_RULES_MANAGE (pm.payer-modifier-rules.manage).

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Before you start

  • Your account must hold the pm.payer-modifier-rules.view permission.
  • Payers must be configured in Payer Management before modifier rules can be assigned to them.
  • An active organization context is required; rules are org-scoped.

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Steps

1

Navigate to Payer Modifier Rules

Go to Practice Management → Payer Modifier Rules (route /pm/payer-modifier-rules). The page loads all currently-effective rules for the organization, sorted by modifier code.
2

Filter by payer

Use the payer dropdown to narrow the list to a specific payer. Select “All Payers” to view all rules.
3

Add a new rule

Click New Rule (requires pm.payer-modifier-rules.manage) to open the PayerModifierRuleFormDialog in create mode.
4

Edit an existing rule

Click the settings icon in the Actions column for any rule to open the form dialog in edit mode.
5

View version history

Click the clock icon in the Actions column to open the RuleVersionHistoryDialog for that rule’s change log.
6

Toggle rule active state

Click the pause (⏸) or play (▶) icon to disable or enable a rule. The changeReason is set automatically to “Disabled by admin” or “Enabled by admin”.
7

Delete a rule

Click the delete icon (🗑) in the Actions column to soft-delete the rule. The rule is removed from the list immediately.

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Key concepts

  • allowed — modifier is permitted for this payer/CPT combination (default badge)
  • required — modifier must be present (secondary badge)
  • forbidden — modifier must not be present (destructive badge)
  • warning — modifier triggers a warning but does not block (outline badge)
Rules have a severity field rendered as a badge: error = destructive badge; other values = secondary badge. Severity controls how claim scrubbing responds to a rule match.
Each rule has effective_from and effective_to dates displayed as “MMM d, yyyy – MMM d, yyyy” or “MMM d, yyyy – ∞” when ongoing. By default, only currently-effective rules are shown (expired rules excluded).
A rule may target a specific cpt_code or apply to all CPT codes for the payer (displayed as “All” in the CPT column when cpt_code is null).
When no rules match filters, an empty state displays “No modifier rules — Create payer-specific modifier rules to validate charges before submission.” with a Create Rule action.

Practice Management

Overview of the Practice Management core.

Governance & parity

Documentation coverage and governance.
This page documents shipped product behavior. It is not medical, legal, or billing advice. Verify against your organization’s policies and applicable regulations before using it for clinical, compliance, or billing decisions. Protected health information (PHI) shown in the product is governed by your tenant’s access controls and is never exposed in this documentation.
  • src/routes/pm.tsx
  • src/cores/pm/pages/PayerModifierRulesPage.tsx
  • src/cores/pm/hooks/usePayerModifierRuleList.ts
  • src/cores/pm/hooks/usePayerList.ts
  • src/platform/permissions/constants.ts