> ## Documentation Index
> Fetch the complete documentation index at: https://docs.patient-experience.commure.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Business rules

> Automated rules that drive eligibility, routing, and payor decisions.

Business rules are automated checks that run when a referral is processed. They evaluate the referral's data against configured rules and determine eligibility, routing decisions, and payor priority.

## What business rules evaluate

| Rule type                      | Description                                                                                         |
| ------------------------------ | --------------------------------------------------------------------------------------------------- |
| **Do Not Readmit**             | Checks patient name + DOB against the DNR list. Passes if the patient is **not** found in the list. |
| **Service area**               | Determines whether the requested disciplines are available at the patient's location.               |
| **Eligibility**                | Runs eligibility through Waystar and Availity.                                                      |
| **Payor scorecards**           | Scores payors by how desirable they are.                                                            |
| **Branch NPIs**                | Validates that the NPI on the referral matches a known branch.                                      |
| **Partnered referral sources** | Identifies whether the referring provider or facility is a known partner.                           |

## When rules run

Business rules run automatically during referral processing (even before the **Pending** status). They also are re-triggered automatically if any dependent data changes (e.g. if zip code is updated, Service Area will be re-checked).

<Info>
  Business rule configuration is managed by administrators. Coordinators can view rule results but cannot modify the rules themselves.
</Info>

## Eligibility

As part of business rule processing, the system runs an eligibility check against the patient's insurance information. The eligibility summary is visible in the referral detail view and shows:

* Whether the patient is eligible for the requested services
* Key insurance details extracted and verified
* Any flags or issues that require manual review