Insurance Services Automation Options

1. What does this feature do? (High-Level Overview)

This feature explains the optional Automation section inside the Insurance Service form and how each option influences note modifier selection or charge splitting behavior. It helps administrators configure predictable automation without changing backend code.

2. Who is this for? (Roles & Permissions)

• Users with manage_insurances: Configure automation values while creating or editing insurance services.
• Billing and clinical users: Do not configure these fields directly, but automation affects how notes and claim lines are produced.

3. Business Rules & Enforcements

• Rule 1: Automation is skipped when a note already has manual modifiers.
• Rule 2: Auto on POS matches the note POS category (telehealth or in-person). Telehealth is determined by is_telehealth=true or POS codes 02/10; otherwise it is treated as in-person.
• Rule 3: Auto on Provider matches the effective provider type (bcba, bcaba, rbt) for the note context.
• Rule 4: Auto on Same Day only applies when same-day notes exist for the same patient, same real provider (provider_id), same CPT, and same date of service, with different POS values; later notes (by time_in) receive the modifier while the earliest does not.
• Rule 5: Same-day automation can update existing notes only when they are not billed and do not already have modifiers.
• Rule 6: Auto on Overlapping stores a target CPT code. During claim processing, if note time overlaps with that target CPT on the same patient/date, charges can be split using the overlapping service pricing/modifier configuration.
• Rule 7: If multiple services match automation conditions, selection priority favors more automation conditions, then more modifier complexity, then non-same-day services, then lowest ID.
• Rule 8: In current UI, Auto on POS options are in-person and telehealth; Auto on Overlapping options reuse the CPT list shown in the form.

4. UI Placement

1. Insurance > Edit Insurance > Insurance Services.
2. Open Add Service or Edit Service modal.
3. Expand the Automation accordion.
4. Configure Auto on POS, Auto on Provider, Auto on Overlapping, and Auto apply on same day.

5. How-To Guide (Step-by-Step)

Scenario A: Apply modifier only for telehealth RBT notes

1. Open service form and expand Automation.
2. Set Auto on POS = telehealth.
3. Set Auto on Provider = RBT.
4. Save the service.
5. Result: automation applies only when both POS and provider-type conditions match.

Scenario B: Configure same-day different-POS behavior

1. In automation, enable Auto apply on same day.
2. Keep other criteria aligned with the intended service (CPT/provider/POS as needed).
3. Save the service.
4. Result: for same-day notes with different POS, later notes can receive the service modifier automatically.

Scenario C: Configure overlapping CPT charge split behavior

1. Set Auto on Overlapping to a target CPT code.
2. Save the service with the intended modifiers and price.
3. When overlapping notes exist against that target CPT, claim generation can split units/charges according to overlap duration.

6. What happens if…? (Edge Cases / FAQ)

• Q: What happens if none of the automation conditions match?
  A: No automated modifier is applied.
• Q: What happens if a user manually sets modifiers in the note?
  A: Automation is skipped for that note.
• Q: What happens if I choose Auto on Overlapping but no overlapping notes exist?
  A: No split is applied; normal charge handling remains.
• Q: Can I select multiple provider values in Auto on Provider?
  A: The UI allows multi-select, but matcher behavior is exact per provider type. For predictable results, configure one provider value per service rule.