Rule Sets and Rule Types

Rule sets are used during the visit verification process to link exceptions on visits to the appropriate reasons and resolutions.

Rule types are all details applicable to a specific rule set.

What are the available rule types to add to a rule set?

Depending on the rule sets configured by your organization, the following rule types are available to add during visit verification configuration.

• Incorrect clock-in location
• Incorrect home phone number on clock in
• Incorrect home phone number on clock out
• Web app clock in
• Web app clock out
• Early start
• Late start
• Incorrect visit date
• Early end
• Late end
• No clock out
• Short visit duration
• Long visit duration
• No work session
• Multiple work sessions
• Incorrect employee
• Interventions not completed
• Visit cancelled
• Visit forms
• Visit premium added
• NEW: Visit Notes
• Not funded
• Client overlapping work sessions

Incorrect clock-in location

This exception will be raised during the verification process if the distance between the GPS location captured when a care provider clocks in using a mobile device and the address where the visit is scheduled to occur exceeds the permitted distance configured as the threshold for this exception. The exception will also be raised if no GPS location was captured upon clock-in or if no visit location is available. Enter a threshold that equals the maximum distance from the visit address that clock-in should occur. The threshold units will be measured in kilometers (km) or miles (mi) depending on which is configured for your organization in Settings>Locale>Time format. Note that this rule type only considers clock-outs from the mobile application.

Incorrect clock-out location

This exception will be raised if the distance between the GPS location captured when a care provider clocks out using the mobile device and the address where the visit is scheduled to occur exceeds the permitted distance configured as the threshold for this exception. This exception will also be raised if no GPS location was captured upon clock-out or if no visit location is available. Enter a threshold that equals the maximum distance from the visit address that clock-out should occur. The threshold units will be measured in kilometers (km) or miles (mi) depending on which is configured for your organization in Settings>Locale>Time format. Note that this rule type only considers clock-outs from the mobile application.

Incorrect home phone number on clock in

This exception will be raised if the Interactive Voice Recognition (IVR) system was used to clock in to a visit, and the phone number used for clocking in did not match the home phone number on the client’s profile. No threshold is required for this rule type.

Incorrect home phone number on clock out

This exception will be raised if the Interactive Voice Recognition (IVR) system was used to clock out of a visit and the phone number used for clocking out did not match the home phone number on the client’s profile. No threshold is required for this rule type.

Web app clock in

This exception will be raised if the web application was used to clock in to a visit. No threshold is required for this rule type.

Web app clock out

This exception will be raised if the web application was used to clock out of a visit. No threshold is required for this rule type.

Early start

This exception will be raised if a care provider clocks in to a visit earlier than the scheduled start time by more than the permitted number of minutes configured as the threshold. Enter a threshold in minutes that equals the amount of time that clock-in should occur prior to the visit scheduled start time.

Late start

This exception will be raised if a care provider clocks into a visit later than the scheduled start time by more than the permitted number of minutes configured as the threshold. Enter a threshold in minutes that equals the maximum amount of time that clock-in should occur after the visit scheduled start time.

Incorrect visit date

This exception will be raised if the date that a care provider clocked in to a visit does not match the scheduled start date of the visit. No threshold is required for this rule type.

Early end

This exception will be raised if a care provider clocks out of a visit earlier than the scheduled end time by more than the permitted number of minutes configured as the threshold. Enter a threshold in minutes that equals the maximum amount of time that clock-out should occur prior to the visit’s scheduled end time.

Late end

This exception will be raised if a care provider clocks out of a visit later than the scheduled end time by more than the permitted number of minutes configured as the threshold. Enter a threshold in minutes that equals the maximum amount of time that clock-out should occur after the visit’s scheduled end time.

No clock out

This exception will be raised if a care provider did not clock out of a visit the same number of times that they clock in to a scheduled visit. No threshold is required for this rule type.

Short visit duration

This exception will be raised if the clocked duration of the visit was shorter than the scheduled duration by more than the permitted percentage of the total duration or number of minutes configured as the threshold. You can enter a threshold as a percentage of the total scheduled duration or in minutes where the threshold equals the maximum amount of time under the scheduled duration that a visit can be without raising an exception.

Long visit duration

This exception will be raised if the clocked duration of the visit was longer than the scheduled duration by more than the permitted percentage of the total duration or number of minutes configured as the threshold. You can choose to enter a threshold either as a percentage of the total scheduled duration or in minutes where the threshold equals the maximum amount of time above the scheduled duration that a visit can be without raising an exception.

No work session

Exception will be raised if there are no work sessions (clock-ins and clock-outs) for a visit. No threshold is required for this rule type.

Multiple work sessions

Exception will be raised if there is more than one work session for a visit. No threshold is required for this rule type.

Incorrect employee

Exception will be raised if the employee who clocked in or out of a visit is not the employee assigned to the visit.

Interventions not completed

Previously named "service tasks not completed", users can now flag visits that are missing a minimum amount of completed interventions. The minimum amount of interventions must be configured when using this rule type, per the image below.

Visit cancelled

Previously, an exception was raised for all visits with cancelled codes in the "Visit Cancelled" rule type. As of November 2022, users can now configure an exception for visits with specific cancelled codes, and for visits with missing cancelled codes, per image below. For all options, users can configure whether to auto-approve or auto-reject those visits as well as the required action type (acknowledgement or reasons).

Visit forms

Exception will be raised if form submissions are found on the visits (with the option to look for specific forms or statuses) AND/OR if there are missing form submissions for the visit. Customize these to indicate what criteria should hold approval of a visit. At least one of the following two configurations must be set (can be both):

• Option 1: Flag visits that have forms
  • Options
    1. Any: if one or more form submission is found, no matter the form, system will flag visit with 'Form found' and provide the list of form names found in a tooltip.
    2. Specific: if one or more form submission from the selected forms is found, system will flag visit with 'Form found' and provide the list of form names found from the selection in a tooltip.
  • Flag forms based on status
    • 1. Not applicable: If this option is selected, system will not look at the statuses of the forms found above before flagging a visit.
      2. When status is: only flag the visit when the form submissions found for a visit are in the selected statuses, in addition to the Any/Specific criteria above. System will flag the visit with 'Form status flagged' and provide the list of form names and statuses found in a tooltip.
      3. When status is not: only flag the visit when the form submissions found for a visit are not in the selected statuses, in addition to the Any/Specific criteria above. System will flag the visit with 'Form status flagged' and provide the list of form names and statuses found in a tooltip.
• Option 2: Flag visits that are missing forms
  • Options:
    • Any: if no form submission is found on the visit, system will flag visits with 'Missing form' and indicate in a tooltip: ‘No form submission found for this visit’
    • Specific: if visit is missing form submissions for 1 or more of the selected forms, system will flag visits with 'Missing form' and provide the list of form names missing from the selection in a tooltip.

    • Missing submission for forms added to visit: in the cases where forms to be completed during the visit are added to the visit prior to its start, system will flag visits where a submission is missing for 1 or more of the pre-selected forms. System will flag visits with 'Missing form' and provide the list of missing submissions in a tooltip.

Example: if you configure the rule in the following fashion with both options, system will flag visits where a submission is missing for one or more of the forms added to the visit AND if a submission is present but not in the Approved status.

Visit premium added

Exception will be raised if there is a visit premium added to the visit. No threshold is required for this rule type.

Not funded

Exception will be raised if there is no funding configured for a visit according to the funding block logic for the service. No threshold is required for this rule type.

NEW: Visit Notes

Users can add, configure and modify the Visit Notes rule type so that the system will flag any visits with a visit note and make either acknowledgement, reason, and/or comment, mandatory as part of that visit. Refer to the steps below for more instructions.

1. Navigate to Accounting Settings> Verification Rule Sets> select rule set to be modified, or create a new rule set. Select "+ Add rule" to add a new rule type.

2. Select "Visit Notes" and determine between "Acknowledgement required", or "Reasons required", and add the reasons as needed.

Client overlapping work sessions

This rule allows customers to flag visits whose work session and/or adjusted time overlaps with the work session (clock-in/clock-out), and/or adjusted time of another visit for the same client.