Advanced Billing Rule Enhancement for Lock-Out Codes

This article describes a 2024 planned feature delivered through the myAvatar Product Roadmap. This information is subject to change.

What are we doing?

Enhancing the 'Combination of Services that cannot be rendered on the same day' field in the Advanced Billing Rule Definition form to allow specifying that the rendering practitioner must be the same for both services. 

Why are we doing it?

Under CalAIM, Lock-out rules only apply to the same practitioner. If the rendering practitioner is different, the two services are not locked-out against each other. Currently, the option in Advanced Billing Rules only evaluates the services codes themselves, not the rendering practitioner of the services as well.  

How are we doing it?

Enhancing the 'Combination of Services that cannot be rendered on the same day' field in the Advanced Billing Rule Definition form to allow specifying that the rendering practitioner must be the same for both services.