Referral Intake
Manage incoming referrals across all sources
12
New Today
7
Pending Review
5
In Progress
89%
Acceptance Rate
All Referrals (12)
New (4)
Pending Review (7)
Accepted (1)
| Patient | Source | Date Received | Urgency | Insurance | Services | Status | SLA |
|---|---|---|---|---|---|---|---|
|
Johnson, Martha A.
DOB: 03/15/1948 · F
|
Hospital St. David's Medical |
02/23/2026 10:32 AM |
● Urgent | Medicare A/B | SN PT | Pending Review | 6h left |
| Davis, Robert L. DOB: 07/22/1955 · M |
Physician Dr. Sarah Patel |
02/23/2026 9:15 AM |
○ Routine | Medicare Advantage UHC |
PT OT | Pending Review | 18h left |
| Williams, Eleanor P. DOB: 11/03/1940 · F |
SNF Sunrise Senior Living |
02/22/2026 4:20 PM |
● Urgent | Medicare A/B | SN | SLA Breached | 2h overdue |
| Chen, David H. DOB: 05/18/1962 · M |
Hospital Dell Seton Medical |
02/23/2026 11:45 AM |
○ Routine | Medicaid | SN HHA | New | 23h left |
| Garcia, Maria L. DOB: 09/28/1971 · F |
Physician Dr. James Wong |
02/23/2026 8:00 AM |
○ Routine | BCBS PPO | PT | Accepted | Complete |
New Referral
Enter patient and referral information
1
Patient Info2
Clinical3
Insurance4
Services5
Review & SubmitPatient Demographics
Emergency Contact
New Referral
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Patient Info2
Clinical3
Insurance4
Services5
Review & SubmitClinical Information
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Clinical Decision Support
New Referral
Enter patient and referral information
✓
Patient Info✓
Clinical3
Insurance4
Services5
Review & Submit
Insurance & Eligibility
Primary Insurance
Eligibility Verified
Secondary Insurance (Optional)
Authorization
No — Medicare Traditional does not require prior auth
New Referral
Enter patient and referral information
✓
Patient Info✓
Clinical✓
Insurance4
Services5
Review & SubmitServices & Assignment
Requested Services
Skilled Nursing (SN)
Physical Therapy (PT)
Occupational Therapy (OT)
Home Health Aide (HHA)
Speech Therapy (ST)
Medical Social Worker (MSW)
Agency Assignment
Patient address is within Austin service area
Documents Received
📄 Discharge Summary Uploaded
📄 Face-to-Face Encounter Uploaded
📄 Physician Orders (485) Pending
New Referral
Review all information before submitting
✓
Patient Info✓
Clinical✓
Insurance✓
Services5
Review & Submit1 Document Pending
Patient Information
NameMartha Anne Johnson
Date of Birth03/15/1948 (77 y/o)
SexFemale
Address1842 Oak Valley Dr, Austin TX 78749
Phone(512) 555-0147
Emergency ContactRobert Johnson (Spouse)
Clinical Information
Primary DxI50.9 — Heart failure
Secondary DxE11.65 — Type 2 DM w/ hyperglycemia
Referring MDDr. Sarah Patel
SourceHospital — St. David's Medical
UrgencyUrgent — Within 24h
Target SOC02/24/2026
Insurance
PrimaryMedicare A/B
MBI1EG4-TE5-MK72
EligibilityVerified
Prior AuthNot Required
Services & Assignment
ServicesSN 3x/wk PT 2x/wk
Duration30 days
AgencySunrise HH — Austin
BranchSouth Austin
Documents
Discharge Summary✓
Face-to-Face Encounter✓
Physician Orders (485)Pending
Estimated PDGM
$2,847.32
MMTA — Cardiac/Circulatory
Early episode · Community entry · Low comorbidity
Referral Accepted Successfully
Referral for Martha Anne Johnson has been accepted and assigned to Sunrise Home Health — Austin (South).
NOA filing deadline: March 1, 2026.
NOA: 5 days remaining
SOC: Scheduled 02/24
Automated Actions Triggered
Visit Schedule
Tuesday, February 24, 2026 — Sunrise Home Health, Austin
All Disciplines
SN
PT
OT
HHA
Tue 24
24
Total Visits
8
Completed
12
In Progress / Upcoming
3
Unassigned
1
Missed
Clinician Schedule
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
E. Parker
SN Wound Care
8:00 – 9:00
M. Johnson ⭐
SN SOC Assessment
10:00 – 11:30
R. Davis
SN Med Mgmt
1:00 – 2:00
H. Liu
SN Cardiac
3:00 – 4:00
J. Wilson
SN Wound
4:00 – 5:00
D. Chen
PT Evaluation
8:00 – 9:00
A. Brooks
PT Treatment
9:00 – 10:00
M. Johnson
PT Evaluation
11:00 – 12:00
S. Adams
PT Treatment
1:00 – 2:00
L. Miller
PT Treatment
2:00 – 3:00
R. Davis
PT Treatment
4:00 – 5:00
T. Brown
SN Assessment
9:00 – 10:00
G. White
SN Diabetic
11:00 – 12:00
P. Garcia
SN Med Mgmt
2:00 – 3:00
F. Moore
SN Wound
4:00 – 5:00
E. Parker
OT Treatment
8:00 – 9:00
D. Chen
OT Evaluation
10:00 – 11:00
B. Taylor
OT Treatment
12:00 – 1:00
S. Adams
OT Treatment
2:00 – 3:00
J. Wilson
OT Evaluation
3:00 – 4:00
M. Harris
SN Cardiac
8:00 – 9:00
C. Lee
SN Assessment
10:00 – 11:00
N. Patel
SN Recert
1:00 – 2:00
R. Kim
SN Diabetic
3:00 – 4:00
⚠ Unassigned Visits (3)
WJ
William Jones
SN Wound Care · 78749 · 1:00 PM
AL
Anna Lewis
PT Treatment · 78704 · 2:00 PM
BT
Betty Thompson
SN Med Mgmt · 78745 · 3:30 PM
Today's Capacity
Sarah Chen, RN5 / 6 visits
Mike Rivera, PT6 / 6 visits Full
Jennifer Torres, RN4 / 6 visits
Lisa Park, OT5 / 6 visits
Karen Nguyen, RN4 / 6 visits
Missed Visit
Claims Management
Revenue cycle — Sunrise Home Health, Austin
$284K
Billed (MTD)
$218K
Collected (MTD)
142
Pending Claims
18
Denied
94.2%
Clean Claim Rate
Accounts Receivable AgingTotal Outstanding: $412,847
▲ 12% of receivables are 90+ days — industry benchmark: <8%
Action needed on aged claims
All Claims (142)
Ready to Submit (8)
Submitted (96)
Denied (18)
Appeals (5)
Paid (1,247)
| Claim # | Patient | Period | Payer | Amount | Status | Filed | Age |
|---|---|---|---|---|---|---|---|
| CLM-4821 | Johnson, Martha MBI: 1EG4-TE5-MK72 |
02/24 – 03/25 | Medicare A/B | $2,847.32 | Submitted | 02/24/26 | 0 days |
| CLM-4798 | Williams, Eleanor MBI: 3RK8-AB2-JL91 |
01/15 – 02/13 | Medicare A/B | $3,124.67 | Denied | 02/14/26 | 10 days |
| CLM-4756 | Davis, Robert UHC: MA-889421 |
01/20 – 02/18 | Medicare Adv | $2,456.00 | Paid | 02/19/26 | 5 days |
| CLM-4712 | Garcia, Maria BCBS: PPO-112847 |
01/10 – 02/08 | BCBS PPO | $1,890.00 | Submitted | 02/09/26 | 15 days |
| CLM-4689 | Chen, David Medicaid: TX-5528190 |
12/28 – 01/26 | Medicaid | $1,642.50 | In Review | 01/27/26 | 28 days |
| CLM-4645 | Parker, Eleanor MBI: 7HN2-KL4-QR82 |
12/15 – 01/13 | Medicare A/B | $2,198.44 | Denied | 01/14/26 | 41 days |
| CLM-4601 | Brown, Thomas MBI: 2DF5-WX8-PT43 |
12/01 – 12/30 | Medicare A/B | $3,412.18 | Paid | 12/31/25 | — |
CLM-4798 — Denied
Action Required
Claim Summary
PatientEleanor Williams
Period01/15 – 02/13/2026
Billed$3,124.67
HIPPS Code3AFKS
PayerMedicare A/B
VisitsSN×6, PT×4
Filing Deadline04/15/2026
Denial Reason: CO-4
Claim Timeline
02/22/2026
Denied — CO-4 modifier error
02/14/2026
Submitted to Medicare MAC
02/13/2026
Scrubbed — passed all edits
02/13/2026
Generated from period ending 02/13
⚠ LUPA Risk Alerts
3 patients
H. Liu
At Risk
1 of 2 visits completed · 8 days left
F. Moore
Monitor
1 of 2 visits completed · 12 days left
R. Kim
Monitor
0 of 2 visits completed · 15 days left
OASIS Assessments
OASIS-E clinical assessments — Start of Care, Recertification, Discharge
6
In Progress
3
Needs Review
42
Submitted (MTD)
2
Past Due
94%
Accuracy Score
Queue (9)
Submitted (42)
Assessment Editor
| Patient | Type | Clinician | Started | Items | Status | Due | |
|---|---|---|---|---|---|---|---|
| Johnson, Martha MRN: 2026-04892 |
SOC | SC Sarah Chen |
02/24/2026 | 28/89 |
In Progress | 02/28 | |
| Davis, Robert MRN: 2026-04835 |
Recert | JT Jennifer Torres |
02/22/2026 | 64/82 |
Needs Review | 02/25 | |
| Parker, Eleanor MRN: 2026-04645 |
Discharge | KN Karen Nguyen |
02/23/2026 | 67/67 |
Needs Review | 02/26 | |
| Liu, Helen MRN: 2026-04901 |
SOC | SC Sarah Chen |
02/20/2026 | 52/89 |
Past Due | 02/22 ⚠ |
OASIS-E Assessment
Martha Johnson — Start of Care · 02/24/2026 · Sarah Chen, RN
M0010-M0150 · Admin
M1000-M1036 · Clinical
M1800-M1870 · Functional
M2001-M2040 · Therapy
GG0100-GG0170 · BIMS/PHQ
J0510-J1800 · Health Cond
O0110-O0500 · Discharge
Assessment Progress
28 of 89 items completed (31%)
📋 M1800-M1870 — Functional Status
0 / 8 itemsM1800
Grooming: Current ability to tend to personal hygiene needs
Ability to tend to personal hygiene needs (i.e., washing face and hands, hair care, shaving or make up, teeth or denture care, fingernail care).
💡 CDS: Score of 1 is consistent with CHF patients post-hospitalization. Document specific limitations observed.
M1810
Current Ability to Dress Upper Body
Ability to dress upper body safely, including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps.
M1820
Current Ability to Dress Lower Body
Ability to dress lower body safely, including undergarments, slacks, socks or nylons, shoes.
💡 CDS: M1810=2 and M1820=2 — consistent pairing. If lower body were scored higher than upper body, document the clinical reason.
M1830
Bathing: Current ability to wash entire body safely
Ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair).
Patient Context
PatientMartha Johnson, 77F
Primary DxI50.9 CHF
TypeStart of Care
SOC Date02/24/2026
Episode30-day · Early
PDGM Grouping (Live)
Estimated Reimbursement
$2,847.32
MMTA — Cardiac/Circulatory
Functional: Medium · Comorbidity: Low
💡Functional scores on this section directly impact PDGM grouping. Current scores → Medium functional level.
Validation Status
✅ M0010-M0150 — Admin items complete
✅ M1000-M1036 — Clinical items complete
⚠️ M1800-M1870 — 4 of 8 items answered
❌ GG0100-GG0170 — Inconsistency detected
○ 3 sections not started
Audit Trail
Sarah Chen saved draft10:45 AM
Assessment created10:32 AM
SOC visit completed10:30 AM
QAPI & Compliance
Quality Assurance & Performance Improvement — Sunrise Home Health, Austin
Quality Dashboard
Star Ratings
PIPs (3)
Survey Readiness
Incident Reports
CMS Star Rating
★★★★★
4.0 Stars
Quality of Patient Care
4.5
Timely Initiation
3.5
Improvement in
Ambulation
Ambulation
4.0
Improvement in
Bathing
Bathing
3.0
Acute Care
Hospitalization
Hospitalization
18.2%
Hospitalization Rate
National avg: 15.4%
↑ 2.1% from last quarter
8.4%
ED Use Rate
National avg: 12.1%
↓ 1.3% from last quarter
72.4%
Improvement in Ambulation
National avg: 68.2%
↑ 3.8% from last quarter
68.9%
Improvement in Bathing
National avg: 65.7%
↑ 1.2% from last quarter
Performance Improvement Projects
Reduce Acute Care Hospitalizations
Progress60%
3 actions complete
2 in progress
1 pending
Improve OASIS Accuracy Score
Progress40%
Timely SOC Visit Compliance
Progress85%
Recent Incidents
Patient Fall — H. Liu
02/22/2026 · No injury · RCA pending
Med Error — R. Davis
02/18/2026 · Wrong dose documented · Corrected
Patient Complaint — E. Parker
02/15/2026 · Scheduling issue · Resolved
Survey Readiness — CoPs
Patient Rights (§484.50)
8/8 Met
✓
Written notice of rights provided at SOC✓
Advance directive policy documented✓
Complaint hotline number provided✓
Transfer/discharge policies accessible
Comprehensive Assessment (§484.55)
5/6 Met
✓
OASIS completed within 5 days of SOC✓
Drug regimen review at each assessment✓
Comprehensive assessment by qualified clinician!
2 overdue OASIS assessments — H. Liu, T. Brown✓
Reassessment at recertification
Care Planning (§484.60)
6/6 Met
✓
Physician-signed plan of care for all patients✓
Care plan reviewed each 60-day period✓
Care plan includes measurable goals
QAPI Program (§484.65)
4/5 Met
✓
Written QAPI plan in place✓
Governing body oversight documented✓
Active PIPs with measurable outcomes!
QAPI committee meeting overdue — last: 01/15/2026✓
Incident tracking and analysis active
Infection Prevention (§484.70)
4/4 Met
✓
Infection control program maintained✓
Staff training on standard precautions current✓
Surveillance and reporting procedures documented✓
Antibiotic stewardship policy in placeOverall Readiness: 27/29 (93%)
Dashboard
Sunrise Home Health — Austin · Tuesday, February 24, 2026
847
Active Patients
↑ 12 this month
1,248
Visits (MTD)
↑ 8% vs last month
$218K
Collections (MTD)
76% of billed
4.0★
CMS Star Rating
Same as last quarter
Visits by WeekLast 12 weeks
Dec 2Dec 30Jan 27Feb 24
Payer Mix
847
Medicare 58%
MA 22%
Medicaid 12%
Commercial 8%
⚡ Action Items 7
● 1 referral SLA breached
● 1 missed visit today
● 2 overdue OASIS assessments
● 3 denied claims need attention
● 3 unassigned visits
● 4 care plans expiring this week
● QAPI meeting overdue
Recent Activity
Sarah Chen completed visit — M. Johnson SOC 11:38 AM
Amy Martinez accepted referral — D. Chen 11:15 AM
Claim CLM-4756 paid — $2,456.00 10:50 AM
Mike Rivera clocked in — D. Chen PT eval 10:02 AM
Jennifer Torres submitted OASIS — R. Davis recert 9:45 AM
Clinician Performance
Sarah Chen, RN
98% on-time
Mike Rivera, PT
96% on-time
Jennifer Torres, RN
94% on-time
Lisa Park, OT
88% on-time
Karen Nguyen, RN
92% on-time
Patient Census
847 active patients — Sunrise Home Health, Austin
847
Active
142
On Service
38
Pending Discharge
12
New This Month
78.4
Avg Age
All Patients (847)
Active Episodes (142)
Pending SOC (6)
Discharged (705)
| Patient | Status | Episode | Primary Dx | Payer | Services | Clinician | Last Visit | Next Visit | |
|---|---|---|---|---|---|---|---|---|---|
MJ |
Johnson, Martha A. 77F · MRN: 2026-04892 |
Active | 02/24 – 03/25 | I50.9 CHF | Medicare | SN PT | S. Chen | Today | 02/26 |
RD |
Davis, Robert L. 70M · MRN: 2026-04835 |
Active | 01/20 – 02/18 | M17.11 OA knee | UHC MA | PT OT | M. Rivera | 02/22 | 02/25 |
EP |
Parker, Eleanor J. 82F · MRN: 2026-04645 |
Discharge Pending | 12/15 – 02/12 | L89.313 Pressure ulcer | Medicare | SN OT | K. Nguyen | 02/23 | — |
DC |
Chen, David H. 63M · MRN: 2026-04910 |
Pending SOC | — | J44.1 COPD | Medicaid | SN HHA | TBD | — | 02/25 |
MG |
Garcia, Maria L. 54F · MRN: 2026-04867 |
Active | 01/10 – 02/08 | S72.001A Hip fracture | BCBS | PT | M. Rivera | 02/23 | 02/26 |
HL |
Liu, Helen T. 71F · MRN: 2026-04901 |
Active | 02/10 – 03/11 | I48.91 A-fib | Medicare | SN | S. Chen | 02/20 | Overdue |
Showing 1–6 of 847 patients
EVV Tracking
Electronic Visit Verification — Real-time clinician monitoring
8
Visits Completed
4
In Progress
12
Upcoming
1
Missed
96.2%
Compliance Rate
Live Clinician Map4 active
SC
MR
JT
LP
KN
In Visit
En Route
Offline
Active Visits Right Now
SC
Sarah Chen → H. Liu
SN Cardiac · Clocked in 2:58 PM
00:32:14
MR
Mike Rivera → S. Adams
PT Treatment · Clocked in 1:05 PM
01:25:08
LP
Lisa Park → S. Adams
OT Treatment · Clocked in 2:12 PM
00:18:44
KN
Karen Nguyen → N. Patel
SN Recert · Clocked in 1:02 PM
01:28:33
Today's EVV Log
| Clinician | Patient | Type | Clock In | Clock Out | Duration | Location | Status |
|---|---|---|---|---|---|---|---|
| Sarah Chen | E. Parker | SN Wound | 8:02 AM | 8:44 AM | 42 min | ✓ Verified | Complete |
| Mike Rivera | D. Chen | PT Eval | 8:05 AM | 9:02 AM | 57 min | ✓ Verified | Complete |
| Sarah Chen | M. Johnson | SN SOC | 10:32 AM | 11:38 AM | 1h 6m | ✓ Verified | Complete |
| Mike Rivera | M. Johnson | PT Eval | 11:05 AM | 11:58 AM | 53 min | ✓ Verified | Complete |
| E. Williams | — | SN Wound | — | — | — | ✗ No data | Missed |
| Sarah Chen | H. Liu | SN Cardiac | 2:58 PM | — | In progress | ✓ Verified | Active |
Care Plans (485)
Physician-signed plans of care — orders, goals, and interventions
98
Active / Signed
14
Awaiting Signature
4
Expiring This Week
6
Recert Due
All Care Plans (118)
Awaiting Signature (14)
Expiring Soon (4)
Recertification Due (6)
| Patient | Plan Type | Period | Physician | Services | Signature | Status | Expires | |
|---|---|---|---|---|---|---|---|---|
| Johnson, Martha | SOC | 02/24 – 04/24 | Dr. S. Patel | SN 3×/wk PT 2×/wk | Pending | Awaiting 485 | 04/24 | |
| Davis, Robert | Recert | 01/20 – 03/20 | Dr. J. Wong | PT 2×/wk OT 2×/wk | Signed 01/22 | Active | 03/20 ⚠ | |
| Parker, Eleanor | Discharge | 12/15 – 02/12 | Dr. A. Ramirez | SN 2×/wk OT 1×/wk | Signed 12/18 | Discharge | Expired | |
| Liu, Helen | SOC | 02/10 – 04/10 | Dr. K. Pham | SN 2×/wk | Signed 02/12 | Active | 04/10 | |
| Garcia, Maria | Recert | 01/10 – 03/10 | Dr. J. Wong | PT 3×/wk | Pending | Awaiting 485 | 03/10 ⚠ |
Fax Integration
Medication Management
Drug regimen review, reconciliation, and adverse event tracking
847
Patients on Meds
92%
Reconciliation Rate
28
DRR Alerts
3
Adverse Events (MTD)
Drug Regimen Review (28)
High-Risk Medications
Adverse Events (3)
| Patient | Alert Type | Medication(s) | Detail | Severity | Clinician | Status | |
|---|---|---|---|---|---|---|---|
| Johnson, Martha | Interaction | Lisinopril + K-Dur | ACE inhibitor + potassium → hyperkalemia risk | Moderate | S. Chen | Under Review | |
| Parker, Eleanor | Allergy | Bactrim (sulfamethoxazole) | Patient has documented Sulfa allergy | Critical | K. Nguyen | Action Required | |
| Davis, Robert | Duplicate | Metoprolol + Carvedilol | Two beta-blockers prescribed — potential duplicate therapy | Moderate | J. Torres | MD Notified | |
| Liu, Helen | Non-Compliance | Warfarin 5mg | Patient reports missing doses 3× this week — INR overdue | Moderate | S. Chen | Under Review |
Critical Alert: Eleanor Parker — Sulfa Allergy
Remittance Advice
ERA/835 processing — payment posting and reconciliation
$218K
Payments (MTD)
84
ERAs Processed
$12.4K
Adjustments
6
Unmatched
Recent ERAs (84)
Unmatched (6)
Adjustments
| ERA # | Payer | Check/EFT | Date | Claims | Total Paid | Adjustments | Status | |
|---|---|---|---|---|---|---|---|---|
| ERA-2026-0842 | Medicare | EFT #48291 | 02/24/2026 | 4 | $9,847.32 | -$412.18 | Posted | |
| ERA-2026-0838 | UHC MA | EFT #48244 | 02/22/2026 | 7 | $14,228.00 | -$890.00 | Posted | |
| ERA-2026-0835 | Medicare | EFT #48201 | 02/20/2026 | 12 | $28,456.89 | -$3,124.67 | 1 Unmatched | |
| ERA-2026-0829 | BCBS | Check #7821 | 02/18/2026 | 3 | $5,670.00 | $0 | Posted |
Payment Trends (Last 6 Months)
Denial Reasons (MTD)
CO-4 Modifier Error7
CO-16 Missing Info4
CO-29 Filing Limit3
PR-1 Deductible2
OA-23 Auth Required2
Settings
Agency configuration, users, and system preferences
General
Agency Profile
Users & Roles
Workflows
Notifications
Payer Contracts
EVV Configuration
Integrations
Security
Billing
Agency Information
Operational Settings
Referral SLA Timer
Maximum hours before referral review is flagged as overdue
SOC Visit Window
Maximum days from referral acceptance to Start of Care visit
Auto-assign Clinicians
Automatically match clinicians to new visits based on skills and geography
EVV Location Verification
Require GPS verification within 0.5 miles of patient address
OASIS Auto-Scrub
Automatically validate OASIS assessments before submission
Claim Auto-Generation
Automatically generate claims at end of 30-day billing period
Users & Access (This Agency)
| Name | Role | Discipline | Status | Last Login |
|---|---|---|---|---|
| Amy Martinez | Intake Coordinator | Admin | Active | Now |
| Sarah Chen, RN | Clinician | SN | Active | 10:28 AM |
| Mike Rivera, PT | Clinician | PT | Active | 8:01 AM |
| Dr. Rebecca Mills | QA Director | Admin | Active | Yesterday |