Override: Changes what's already in the outputs for a specific condition. For example, swap the CPT code for a specific payer group, or change the POS code for telehealth encounters.

Additive: Adds something on top of the standard outputs. For example, add an interactive complexity add-on code when a provider checks a specific encounter attribute.

Payer group

Program

Encounter attribute

Diagnosis

Duration range (e.g., 0–15 min = one CPT code, 16–37 min = another)

Client age (e.g., different CPT code for clients under 18)

Encounter creator

Multiple triggers can be combined with AND logic

CPT code

Claim type (professional vs. institutional)

Billing provider

Modifiers (add or remove)

Add-on codes

Value codes

Place of service

Min/max units

Secondary payer as primary (for Medicaid-as-secondary scenarios)

Calendar month claim split

If a credential-based modifier override is not firing, the most common cause is that the provider's credential has not been added to their user profile. Add the credential under user configuration first, then configure the override trigger in the service rule.

When a provider holds multiple licenses (e.g., LPCC and LICDC), use the Credentials feature on the user profile combined with credential-based override triggers to apply the appropriate modifier per session.

Uncheck "Use Fee Schedule" to set a flat custom rate for the rule.

Important: When a custom rate is used, add-on codes will not reference any fee schedule and will bill at $0. Keep "Use Fee Schedule" checked if you want payer-specific rates to apply to add-on codes.

Bill for admit day: Bill for the day even if the client was admitted partway through.

Do not bill for discharge day: No billing on the discharge day even if services occurred.

This is the standard configuration for IOP, PHP, detox, and residential programs.

Automatically generates services without requiring a documented encounter.

Common for residential treatment on days when clients are present but no clinical encounters are logged.

Services run on a nightly sweep — expect a delay of up to one day after a change.

Multiple autogen rules can run for the same client on the same day.

If a client is discharged and readmitted on the same day, no per-diem service will be generated for that day.

Force each service to its own claim: Toggle in Advanced Options.

Split by calendar month: Automatically splits claims when services span a month boundary. Required for certain payer configurations including MN Medicaid.