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Use caseUC0244

Catch a health plan's late notices and weak proof

Before a covered stay ends, the plan must warn the member in time to appeal, and hold proof it arrived. This app reads the authorization and the delivery record, and tells you when the notice is due and whether the proof on file counts.

For the notice and appeals coordinatorHealthcare

Why it matters

Today's manual process, and the same job with the app

A notice and appeals coordinator at a Medicare health plan, working down this week's notice-due report.

✕Today's manual process

1Open this week's report of every stay closing in on its covered days.
2Read the authorization and the notes to work out which line actually governs now.
3Open the delivery folder to see who signed, and whether a time was recorded.
4Miss a weak signature and the compliance check closes on evidence that proves nothing.
Every stay judged from memory

✓With the app

1The week's report sorts itself the moment the records are read.
2Each authorization is read and the governing line is named, with its wording quoted.
3Each delivery record is read and the signature is checked against what it actually shows.
4A weak signature stays open with the exact line that shows why, quoted in full.
Every proof checked against the record

See it work

One real case: what the app reads, step by step

At Stonebeck House, the authorization still covers June 16, but the notice was only signed in the ward's own visitor ledger, not on the notice itself.

Catch a health plan's late notices and weak proofReference appBuilt to be shaped to your process
  1. 1The authorization on file Covers the member through June 16, unrevised since the day it was written.
  2. 2The notice deadline Two days back from the last covered day: the notice is due June 14.
  3. 3What the delivery record says A name in the ward's own ledger. The notice itself was left unsigned.
  4. 4The check stays open A ledger signature does not prove the member signed the notice itself.

For engineers

How it is built, and how we measured it

All fourteen steps of the build are written up, from the business case to running it in your own environment.

Kit overview →
0 of 52checks closed on weak proofmeasured in 06 Evals →
60 of 60notice dates computed exactly rightmeasured in 06 Evals →
57 of 60readings right, citation includedmeasured in 06 Evals →
0.23¢to check one snapshotmeasured in 07 Unit cost →

The build, step by step

14 steps

Make it yours

What you see is a reference app. We shape it to how you work.

Every part of it is built to change, and none of it means starting over.

Your rulesYour own notice-timing standard, your watch cadence, and what counts as a valid signature.
Your recordsYour own authorization table, utilization-review notes and delivery records, in the format you keep them.
Your systemsReads from your own authorization and delivery systems; a worklist row can post straight to your queue.
Your screensThe columns, statuses and wording your notice desk already uses.

Want this for your team?

Talk to us

We can run this on your own notice-due report, with your own timing rules, inside your environment.

Talk to us →
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