Edit modifier rules

Outcome

Modifiers are auto-injected on the right charges, validation rules catch missing modifiers before submission, and you can simulate the combined behavior end-to-end before turning anything on for real claims.

Prerequisites

Scope	What it lets you do
billing.rules.read	View injection rules and validation rule sets
billing.rules.write	Add / edit injection rules; edit validation YAML

Familiarity with the rules engine workflow (5.3) — modifier validation is just a kind of rule under the regular engine.

Three sibling tabs

Configuration → Modifiers has three tabs:

Tab	What it controls
Injection	Auto-add modifiers when a charge matches a pattern.
Validation	Read-mostly view of modifier_validation rules across the engine. Edits deep-link into the rules editor.
Simulator	Run injection + validation on a sample charge with no DB writes.

Injection tab

Each injection rule is a row with:

Field	Example
Procedure code	H2014
Modifier added	HQ
Conditions	lineOfBusiness=MEDICAID, payer=*, state=OH
Priority	100 (lower = earlier)
Active	toggle

1. Click + New rule to add an injection. The form validates the modifier against code_set_modifier — modifiers not in the master list are rejected to prevent typos sneaking into outbound EDI.

2. Set conditions to scope the rule. A rule with payer = * applies everywhere; a payer-scoped rule overrides a tenant-wide rule for that payer only.

3. Save. The rule fires on the next claim build for charges matching the pattern.

Validation tab

Validation rules live in the regular rules engine under kind PRE_SUBMIT_VALIDATE. The Validation tab is a focused view that shows only rule sets containing kind: modifier_validation rules.

Click any rule set to deep-link into the rules editor at the right kind and scope. Edits go through the standard draft / submit / approve lifecycle.

Simulator tab

Paste a sample charge JSON and click Simulate. The platform:

1. Runs the injection rules to apply auto-modifiers.
2. Runs the validation rules.
3. Returns the result in a side-by-side panel: original → after-injection, plus any validation issues.

The simulator never writes to the DB. It mirrors the scrubber's order exactly — including the deliberate non-application of injection rules during validation, so you see what staff would see when they hit "validate".

Steps to add a modifier injection rule end-to-end

1. Open the Injection tab, click + New rule. Fill in code, modifier, conditions, priority. Save.

2. Open the Simulator tab. Paste a charge that should trigger the new injection. Click Simulate.

3. Confirm the modifier was added. If not, check conditions — most often the simulator's payer or state context does not match.

4. Optional: open the Validation tab and confirm there is a modifier_validation rule that requires the modifier you just injected. If the injection were ever removed, the validation rule still keeps bad charges from going out.

Validation

Check	Expected
New injection rule visible	Yes, on the Injection tab.
Simulator applies the injection	Yes, on a matching sample charge.
Simulator does not apply on a non-matching sample	Correct — confirms the conditions are right.
Live charge picks up the modifier	Build a real charge under the matching payer/state; modifier is on the line.

Troubleshooting

Symptom	Cause	Fix
Save returns modifier not found	The modifier isn't in code_set_modifier	Modifiers must be standard 2-character codes. Confirm the modifier exists.
Simulator returns "no injection"	Conditions exclude the sample	Loosen conditions, or set the simulator's payer / state to match the rule's scope.
Validation tab is empty	No rule set carries modifier_validation rules	Add such a rule under 5.3 — Edit rules engine YAML.
Modifier appears twice on outbound EDI	Two injection rules at different scopes both fire	Set the more-specific rule's priority higher, or deactivate the redundant rule.

Next

5.5 — Manage ingestion mappings