Getting started with Claims Rules

Updated 4 months ago by Jill Bowers

Creating and applying customized rules to your profile helps ensure that all the assignments and estimates worked on by your profile users follow certain protocols. After they are created, the claims rules are used as parameters in Xactimate to check that important information has been provided, inspection fields have been populated, and other imperative information has been included. 

In the past, we used Inspection Rules to meet the requirements of various profiles. Building these rules or even simply enabling them took a good deal of time and effort and cost users time and money.   

Claims Rules are different. With the new Xactimate Admin tool, profile owners can easily view Xactware rules (rules that were used before as Inspection Rules), enable them or disable them for their profile or instance, easily work with account managers and professional services to create rules in a fast and efficient manner, build different types of rules that were not available before, and much more. 

Claims Rules pros and cons

Pros
  • Xactimate can create and update claims rules at any time.  
  • Rules can be created and updated without releasing code changes to Xactimate. 
  • New rules can be created and implemented outside of the normal release cycle. 
  • They allow for a more dynamic range of rules. 
  • We can create rules that are precise, detailed, and tied to a broader range of estimate data. 
  • Claims Rules provide the freedom to create new, unique rules that were not possible with Inspection Rules. 
  • The process of making rules, from receiving the request to implementing the rule, is much faster.  
  • We can use estimate data to create rules.  
  • We gather information based on claims rules data to add value to future reports.  
  • Claims Rules take significantly less time to create than the old Inspection Rules. 
Cons 
  • Because we can create vastly more claims rules than inspection rules, it may take more time to check claims rules than inspection rules to ensure thoroughness and accuracy.  
  • Migrating from Inspection Rules to Claims Rules is permanent. You cannot return to Inspection Rules after this change is implemented.  
  • When you migrate to the new Claims Rules engine, bypass data in your estimates is erased, and you must re-enter bypass data. For example, if an Inspection rule notified you that some information was missing from an estimate, but the user entered a bypass note explaining why that information was missing, the bypass note would no longer exist in Claims Rules, and that note and other bypass notes would need to be added once again. 

How do I switch to Claims Rules? 

To switch to Claims Rules, speak with your account manager. They will reach out to our professional services teams and, if needed, development teams. Together, they will work with you to create a personalized plan for rules that fit your needs. 

How do Claims Rules work? 

After speaking with your account manager, your manager speaks with our Professional Services team and a rule request is created. With the new Claims Rules engine, the possibilities for rules are broader, encompassing simple rules to more complex ones. Here are some general examples: 

  • If you have x item, you should have y item. 
  • If you have x item, you shouldn’t have y item. 
  • If you have x item, and you don’t have y item, and your grand total is greater than $50,000, you should have z item and review the grand total. 
  • The quantity of item x should be a factor of the quantity of item y. 
  • If the estimate is in a specific status, you should have a specific item added to the estimate. 
  • If the estimate is in a specific status, certain items should not include depreciation. 

After the rules are created, they save to the cloud and then sync with Xactimate. The rules and the associated estimate pass through the rule engine, which notifies the users of any advisories, missing data, and other violations. 

For more information about Claims Rules, contact your account manager. 


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