Advanced Billing Rules Example

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In order to better gain an understanding of the billing rules structure we will create a more advanced billing rules platform. In this example we will create a billing platform whereby a clinician charges more than other clinicians and this price is variable depending upon the number of slots he has available on that given day. Furthermore, the clinic will also charge a fee to the insurance company for the use of the clinic.


This can be split up in to two separate rule groups, one per invoice:


  • A simple fee charged by the clinic


  • A variable fee charged by a clinician


We’ll begin with the clinic fee. In our case we’ll use our insurance company named ‘Cypher Insurance’ as our patient’s insurer.


As with the simple rules we’ll need to create a charge band for these patients in the billing rules section (Start Page > Admin > Billing rules). As our company is not set to internal we must first add the company to the companies panel. Typing the first few letters in the ‘Add companies’ box brings up the company we were looking for


click it to add this company to the list.


 Clicking the small + next to the company will allow us to create new rules, add a new charge band. We’ll be calling our charge band ‘Cypher Insurance Default Charge Band’. Once we click off of the charge band the new charge band will appear below the company.




Underneath this we will create the price list for the clinic fees. Click ‘Add a Rule’ and select ‘New Price List...’, we will name our rule ‘Cypher Insurance Clinic Fees’. The price type will be ‘Total Charged Price’ and we will uncheck the box next to ‘Provide Services with Prices?’ - By doing this we are defining that the price list contains prices but does not provide the services by default. With this configured we can add our service prices.



With the price list complete, we can add this rule to our charge band by clicking on the charge band, followed by ‘Add Rule’ - add your clinic fee price list here.



We unchecked ‘Provide Services with Prices’ and as such this rule alone will provide no services, this way we can limit the services available. Add a new rule here and select ‘New Provide Services Rule’, we’ll be naming our rule ‘Dr Wommack’s Services’.




We will use this rule so that any appointment where Dr. Wommack is the primary doctor will be limited to only procedures that Dr. Wommack can perform. We’ll open ‘Dr Wommack’s Services’ again and set the primary doctor to Wommack, Michael and tick the services Dr. Wommack can provide.



Adding this to our ‘Cypher Insurance Default Charge Band’ will now allow ‘Rehab Initial’ and ‘Brain Scan’ appointment types and will allow the procedure ‘Heart Surgery’ to be added at the prices stated in the ‘Cypher Insurance Clinic Fees’ price list. You may repeat this process for each of your clinician’s to avoid booking the wrong appointment types.



 Now we can move on to create the variable price clinician fee. We’ll add a new rule and select ‘New Dynamic Price Rule’ naming our new rule ‘Dr Wommack’s Special Variable Prices'. The primary doctor will be set as Dr. Wommack and the other configurations will remain as default.

 We’ll select ‘Rehab Initial’ as our variable price appointment and set up the price bands as below:

This configuration means that an ‘Rehab Initial’ appointment will cost £20 if there are more than 3 appointments available, £30 if there are 3, £40 if there are 2 and finally £50 if it is the last appointment available on that day.



The final rule we have to create here is a price list that all other doctors use. This price list will be identical to the ‘Cypher Insurance Clinic Fees’ price list from earlier. We will give this price list the name ‘Cypher Insurance Consultant Fees’.


Once you have created these rules we must group them together to make use of the ‘Multiple Creditors’ feature here. To create a group of services we use a ‘Rule Set’. Under the Cypher Insurance company we will add a new rule and select ‘New Rule Set’ and call this ‘Cypher Insurance Consultants Charges’. Adding the ‘Dr Wommack’s Services’, ‘Dr Wommack’s Special Variable Prices’ and ‘Cypher Insurance Consultant Fees’ completes this rule set.


As described earlier in the billing rules section of this manual, we must move the most general rule to the bottom, in this case it is the ‘Cypher Insurance Consultant Fees’ which applies to every doctor. Your billing rules should now look as follows:


We can add this rule set into our ‘Cypher Insurance Default Charge Band’. Open the charge band where you will see the ‘Additional Creditors’ section. We can add our rule set here by clicking ‘+ Default Rule Set...’ and selecting our rule set.


The rules added here will generate invoices from the clinician’s ‘Billing Company’ (this is set in the clinician home page). By opening Dr. Wommack’s page we can see this is the ‘Michael Wommack’ company.

When the appointment is now booked the two invoices will now be raised, one from the clinic and one from the clinician’s billing company.