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 Info

2

Clinical

3

Insurance

4

Services

5

Review & Submit

Patient Demographics

Last Name *

First Name *

Middle Name

Suffix

Date of Birth *

Sex *

SSN (last 4)

Preferred Language

Address *

Phone (Primary) *

Phone (Secondary)

Emergency Contact

Name

Relationship

Phone

New Referral

Enter patient and referral information

✓

Patient Info

2

Clinical

3

Insurance

4

Services

5

Review & Submit

Clinical Information

Primary Diagnosis (ICD-10) *

Search by code or description

Secondary Diagnosis

Referring Physician *

Physician NPI

Referral Source *

Referral Source Facility

Urgency *

Anticipated SOC Date

Clinical Summary / Reason for Referral

💡

Clinical Decision Support

Based on the primary diagnosis (CHF) and hospital discharge, this patient may qualify for PDGM clinical grouping MMTA — Cardiac/Circulatory. LUPA threshold: 2 visits per 30-day period.

New Referral

Enter patient and referral information

✓

Patient Info

✓

Clinical

3

Insurance

4

Services

5

Review & Submit

Insurance & Eligibility

Primary Insurance

Payer *

Medicare ID (MBI) *

Effective Date

End Date

✅

Eligibility Verified

Medicare Part A/B active. Home health benefit available. No existing home health episodes. Verified 02/23/2026 at 10:45 AM.

Secondary Insurance (Optional)

Payer

Policy Number

Authorization

Prior Authorization Required?

No — Medicare Traditional does not require prior auth

ℹ️

Medicare Traditional does not require prior authorization for home health services. NOA must be filed within 5 calendar days of Start of Care.

New Referral

Enter patient and referral information

✓

Patient Info

✓

Clinical

✓

Insurance

4

Services

5

Review & Submit

Services & Assignment

Requested Services

Skilled Nursing (SN)

Frequency

Duration

Physical Therapy (PT)

Frequency

Duration

Occupational Therapy (OT)

Home Health Aide (HHA)

Speech Therapy (ST)

Medical Social Worker (MSW)

Agency Assignment

Assigned Agency *

Patient address is within Austin service area

Branch (Optional)

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

✓

Services

5

Review & Submit

⚠️

1 Document Pending

Physician Orders (485) have not been uploaded. You can submit the referral now and add orders later, but the SOC visit cannot proceed without signed orders.

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

✓ Patient record created (#2026-04892)
✓ Care team notified — SN and PT coordinators
✓ NOA filing reminder set for 02/28
✓ SOC scheduling task created
✓ Eligibility verification logged to audit trail

📋

Referral Queue

Process more referrals

📅

Schedule SOC

Assign clinician & time

📑

Create Care Plan

Build 485 & route signature

🧾

Patient Onboarding

Verify demographics & consent

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

Eleanor Williams — SN Wound Care was scheduled for 9:00 AM. No EVV clock-in recorded.

Scheduling & Rescheduling Workflow DemoFRD 21.1

New Visit Scheduling

i

Open Visit Board

Match by discipline, geography, language, continuity preference, and next available slot.

Referral: Martha Johnson (SOC)Needs RN today, Spanish-speaking preferred, ZIP 78758

Unassigned

Visit WindowTue Feb 24, 2026, 10:00 AM - 12:00 PM

2h window

JT

Jennifer Torres, RN

4.2 miles away, next slot 11:30 AM

94 Match

KN

Karen Nguyen, RN

5.8 miles away, next slot 12:00 PM

81 Match

Rescheduling & Conflict Checks

!

Conflict Detected

Eleanor Williams missed 9:00 AM visit. Original clinician now double-booked at 1:00 PM in another ZIP.

9:12 AM

Missed visit auto-flagged

No EVV clock-in within grace window.

9:25 AM

Patient contacted

Patient requested afternoon replacement visit.

Next Action

Select replacement slot

Top option: 2:30 PM with Karen Nguyen, RN.

Open Visit Board (Eligible Clinicians)

SN

Eleanor Williams - Wound Care Follow-up

78741 - target 2:00 PM - continuity preferred

PT

Anna Lewis - PT Treatment

78704 - target 2:00 PM - bilingual preferred

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

0-30d · $173K

31-60d · $116K

61-90d · $74K

90+d · $50K

▲ 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

The procedure code is inconsistent with the modifier used. Missing GT modifier for telehealth visit on 01/22.

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

1 of 2 visits completed · 8 days left

At Risk

F. Moore

1 of 2 visits completed · 12 days left

Monitor

R. Kim

0 of 2 visits completed · 15 days left

Monitor

Create Claim

Build and scrub a claim before submission

Claim Header

Parent Organization ID

Agency ID

Branch ID

Patient

Payer

Billing Period

TOB

Statement Covers Through

Diagnosis & Service Lines

Primary Diagnosis (ICD-10)

Secondary Diagnosis

Rev Code	HCPCS	Description	Units	Charge
0551	G0299	Skilled Nursing Visit	4	$820.00
0421	G0151	Physical Therapy Visit	2	$410.00
0270	A6216	Wound Dressing Supply	6	$216.00

Total Charges: $1,446.00

Claim Scrubber

🧪

Pre-Submission Validation

Run payer and CMS edits before claim creation to improve clean-claim rate.

Creation Summary

Ready to Submit

Claim IDCLM-4902

Expected Reimbursement$1,312.28

LUPA RiskLow

AttachmentsOASIS + Visit Notes

Validation Checklist

✓Tenant scope validated (Parent/Agency/Branch)

✓Provider NPI and credentials active for service dates

✓Visit documentation and EVV confirmed for billed services

!Referring physician signature due in 2 days

OASIS Assessments

OASIS-E assessments with type-aware rules: SOC, ROC, Recertification, Transfer, Discharge

7

In Progress

3

Needs Review

42

Submitted (MTD)

2

Past Due

95.1%

Scrub Pass Rate

Queue (10)

Submitted (42)

By Type

Assessment Editor

Patient	Type	OASIS Version	Clinician	Started	Items	Status	Due
Johnson, Martha MRN: 2026-04892	SOC	OASIS-E1 2026	SC Sarah Chen	02/24/2026	28/89	In Progress	02/28
Davis, Robert MRN: 2026-04835	Recert	OASIS-E1 2026	JT Jennifer Torres	02/22/2026	64/82	Needs Review	02/25
Parker, Eleanor MRN: 2026-04645	Discharge	OASIS-E1 2026	KN Karen Nguyen	02/23/2026	67/67	Needs Review	02/26
Liu, Helen MRN: 2026-04901	SOC	OASIS-E1 2026	SC Sarah Chen	02/20/2026	52/89	Past Due	02/22 ⚠
Chen, David MRN: 2026-04910	ROC	OASIS-E1 2026	SC Sarah Chen	02/24/2026	19/86	In Progress	02/27

New OASIS Assessment

Select assessment type and initialize OASIS-E item set with version-aware rules

Assessment SetupRequired

Patient

Assessment Type

Assessment Date

Clinician

OASIS Version

Source Workflow

Type-Aware Included Sections

M0010-M0150 AdminIncluded

M1000-M1036 ClinicalIncluded

M1800-M1870 FunctionalIncluded

GG0100-GG0170 Function/CognitionIncluded

Transfer/Discharge O-sectionConditional

i

FRD OASIS Requirements

Supports full OASIS-E set, type-specific rendering, skip logic, CDS flags, and pre-submit scrubbing.

Initialization Checks

OK Patient demographic profile loaded

OK Tenant scope (Parent/Agency/Branch) validated

OK Clinician credentials active for service date

! Prior assessment exists - prefill enabled

Expected Item Count

SOC89 items

ROC86 items

Recertification82 items

Transfer67 items

Discharge67 items

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%)

Version rulesetOASIS-E1 / 2026

Skip logic9 items currently skipped by type/path

Contradiction checks1 active error, 2 warnings

CMS scrub stateNeeds correction before submit

🧠 GG0100-GG0170 — Function & Cognition

1 error

GG0130

Self-Care — Eating, oral hygiene, toileting hygiene (admission performance)

Rate usual performance at admission using GG scale. This item is checked against M1800-series function responses.

06 Independent 05 Setup or clean-up assistance 04 Supervision or touching assistance 03 Partial/moderate assistance 02 Substantial/maximal assistance 01 Dependent

💡 CDS: Current GG0130=06 conflicts with M1810=2 and M1820=2. Consider 03-04 range if dressing requires help.

🏥 M1000-M1036 — Clinical Status

7 / 8 items

M1033

Risk for Hospitalization

Select all factors present that indicate hospitalization risk at SOC/ROC.

Multiple hospitalizations in past 6 months History of falls Recent decline in mental, emotional, or behavioral status Three or more chronic conditions

💡 CDS: CHF diagnosis and recent admission support hospitalization risk selection. Document care mitigation plan in visit note.

Patient Context

PatientMartha Johnson, 77F

Primary DxI50.9 CHF

TypeStart of Care

VersionOASIS-E1 (2026)

SOC Date02/24/2026

Episode30-day · Early

Skip Logic9 auto-skipped

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

✅ Type skip logic — 9 items intentionally skipped

⚠️ M1800-M1870 — 4 of 8 items answered

❌ GG0130 inconsistency with M1810/M1820

○ 2 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

4.0

Improvement in
Bathing

3.0

Acute Care
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

Target: 15% → National benchmark
Owner: Dr. Rebecca Mills, QA Director

Active

Progress60%

3 actions complete 2 in progress 1 pending

Improve OASIS Accuracy Score

Target: 97% accuracy rate
Owner: Sarah Chen, Clinical Lead

Active

Progress40%

Timely SOC Visit Compliance

Target: 95% within 48 hours of referral
Owner: Amy Martinez, Intake Coord

On Track

Progress85%

Recent Incidents

Patient Fall — H. Liu

02/22/2026 · No injury · RCA pending

Open

Med Error — R. Davis

02/18/2026 · Wrong dose documented · Corrected

Resolved

Patient Complaint — E. Parker

02/15/2026 · Scheduling issue · Resolved

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 place

🛡️

Overall Readiness: 27/29 (93%)

2 items need attention before next survey. Address overdue OASIS assessments and schedule QAPI committee meeting.

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

Patient Management Worklist

Martha Johnson - CHF episode monitoring

30-day period day 2, SN/PT active, NOA filed

On TrackCare Plan SignedEVV 2/2 compliant

Helen Liu - overdue SN follow-up

No completed visit in 5 days, arrhythmia diagnosis

High RiskVisit OverdueCall Caregiver

David Chen - pending SOC activation

Onboarding complete except authorization and clinician assignment

Pending SOCAuth Needed

Care Coordination

11:38 AM

Martha Johnson SN SOC completed

OASIS draft started, medication reconciliation complete.

10:15 AM

David Chen eligibility verified

Awaiting payer authorization response.

Confirm wound closure status and physician order.

Risk and Follow-up Queue

Helen Liu

A-fib + overdue SN visit

Escalated

Eleanor Parker

Discharge documentation pending

Due Today

David Chen

SOC blocked by authorization

Pending

Quick Actions

Patient Onboarding

Identity, eligibility, consent, and tenancy validation before SOC activation

1

Referral Accepted

2

Patient Onboarding

3

Care Plan

4

SOC Scheduling

Identity and DemographicsValidated

Legal Name

Date of Birth

MRN

Phone

Address

Language

Eligibility and AuthorizationPending Auth #

Primary Payer

Secondary Payer

Eligibility Status

Prior Authorization #

i

FRD workflow linkage: Referral Intake -> Eligibility & Authorization -> Care Plan Development.

Consents, Contacts, and Care Team AssignmentIn Progress

HIPAA Consent

Treatment Consent

Emergency Contact

Primary Care Physician

Assigned Intake RN

SOC Target Date

Safety and Infection Control Flags

Tenancy Scope Validation

ParentOrganizationID: PARENT-0012 AgencyID: AGY-ATX-04 BranchID: BR-SOUTH-02

OK

All patient records are scoped to Parent/Agency/Branch per FRD section 2.1.

Onboarding Checklist

Patient identity verifiedDone

Eligibility verifiedDone

Authorization capturedPending

Consent documents signedDone

Care team assignedDone

Audit log createdDone

!

Blocking Item

Prior authorization number is still pending. Complete follow-up before SOC if payer requires auth.

OK

Patient Onboarding Completed

Martha Anne Johnson is now onboarded under Sunrise Home Health - Austin South. Demographics, tenancy scope, and consent package are validated.

LOG

Workflow Actions Triggered

Patient status updated to Onboarding Complete
Care plan workflow remains active (CMS-485)
SOC scheduling unblocked pending auth rules
Audit trail entry written with user/time context

PAT

Patient Census

Return to patient list

POC

Build Care Plan

Continue 485 workflow

SOC

Schedule SOC

Assign first visit

REF

Back to Referrals

Process next intake

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 (485/486)

Physician-signed plans of care — orders, goals, and interventions

FRD 20.2

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)

Certification & Recertification Alerts

Robert Davis

Recert due in 23 days (03/20/2026)

Monitor

Maria Garcia

Recert due in 13 days (03/10/2026)

Action Required

Martha Johnson

Initial certification SLA ends 03/01/2026

Signature Pending

CMS-486 Medical Update Workflow

Helen Liu

Medication change after cardiology follow-up

Draft 486

Eleanor Parker

Wound status improved, discontinue SN dressing order

Needs Review

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

Unsigned 485s are automatically faxed to the ordering physician. 14 pending signatures — average turnaround time: 3.2 days.

Create Care Plan

Generate CMS-485/486 from OASIS and clinical documentation

1

Referral Accepted

2

OASIS/Clinical Data

3

Build 485/486

4

Physician Signature

Plan SetupDraft

Patient

Plan Type

Certification Start

Certification End

Ordering Physician

Signature Workflow

Services and Goals

Skilled Nursing

Physical Therapy

OT / ST / HHA

Visit Constraints

Clinical Goals

Interventions / Special Orders

Order LifecycleNew / Changed / Discontinued

SN frequency: 3x/week

New

Needs Signature

Derived from SOC OASIS findings

PT eval + treat

New

Needs Signature

Mobility decline and fall-risk score elevated

PRN edema protocol

Changed

Review

Threshold updated from 3 lb to 2 lb/day

Daily wound dressing

Discontinued

Resolved

No active wound documented on SOC

Compliance Readiness

OASIS source linkedYes

485 required fields complete18/18

486 update requiredNo

Certification window validValid

Signature path selectedYes

Physician Signature Path

E-sign

Secure sign link with timestamped attestation.

Verbal + Counter-sign

Log verbal order now, collect signature later.

Fax-back

Send 485 packet to office fax queue.

ℹ

FRD Coverage

Supports CMS-485 generation, CMS-486 updates, physician signature workflows (e-sign, verbal + counter-sign, fax-back), and order lifecycle tracking.

CMS-485 Generated

Draft packet assembled from OASIS and clinical documentation - ready for physician signature routing

✓

Generation Completed

CMS-485 packet CP-2026-04892-v1 created on 02/25/2026 at 2:06 PM with full order lifecycle and attestation trail.

Generated Packet SummaryDraft v1.0

PatientMartha Johnson (MRN 2026-04892)

Plan TypeSOC CMS-485 Initial Certification

Certification Window02/24/2026 - 04/24/2026

Ordering PhysicianDr. Sanjay Patel, MD

Signature WorkflowE-sign (default)

Source DataOASIS SOC + SN/PT clinical notes

Order Lifecycle ResultNew / Changed / Discontinued

SN frequency: 3x/week

New

Needs Signature

Mapped from OASIS functional/risk profile

PT eval + treat

New

Needs Signature

Imported from therapy recommendation

PRN edema protocol

Changed

Review

Threshold updated from cardiology note

Daily wound dressing

Discontinued

Resolved

No active wound documented in SOC

Required Next Steps

Step 1 Complete

CMS-485 packet generated and validated

Step 2 Pending

Route to physician signature path (e-sign / verbal + counter-sign / fax-back)

Step 3 Pending

Activate signed orders and unlock scheduling

!

Certification Alert

Physician signature required by 03/01/2026 to meet certification SLA and avoid SOC delays.

Generated Artifacts

CMS-485 PacketCP-2026-04892-v1

Attestation Log2 entries

Recert TriggerScheduled (day 50)

CMS-486 NeedNot required now

Aligned to FRD 20.2: CMS-485 generation, 486 pathway, signature routing, certification/recert tracking, and order lifecycle.

Care Plan Signature Routing

Finalize 485 packet, capture physician signature, and activate orders

Packet StatusAwaiting Physician Signature

PatientMartha Johnson (MRN 2026-04892)

PlanSOC CMS-485 (02/24/2026 - 04/24/2026)

PhysicianDr. Sanjay Patel, MD

Signature MethodE-sign request (sent 2:14 PM)

Certification Deadline03/01/2026 (5-day SLA)

⚠

SOC scheduling remains blocked until signed physician orders are received.

Signature ActionsAll actions are audit logged

CMS-485 packet

v1.0

Pending Signature

E-sign request sent 02/24 2:14 PM

Counter-sign task

v1.0

Not Started

Will open if verbal order used

CMS-486 update

n/a

Not Required

No medical update trigger yet

Audit record

2 entries

Current

Referral to care plan generation logged

Timeline

2:06 PM

CMS-485 generated from OASIS + clinical notes

2:10 PM

Plan reviewed by Intake Coordinator (Amy Martinez)

2:14 PM

E-sign request sent to physician inbox

Pending

Physician signature + plan activation

✓

Ready to Activate

Once signed, orders transition to Active and scheduling unlocks automatically.

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

Bactrim was prescribed by an external provider. Documented Sulfa allergy in patient record. Physician notification sent at 9:15 AM — awaiting response. Do not administer.

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)

Sep

Oct

Nov

Dec

Jan

Feb

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

Agency Name

NPI Number

Medicare Provider #

Tax ID (EIN)

Address

Phone

Fax

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

Referral Intake

New Referral

Emergency Contact

New Referral

New Referral

Primary Insurance

Secondary Insurance (Optional)

Authorization

New Referral

Requested Services

Agency Assignment

Documents Received

New Referral

Documents

Visit Schedule

New Visit Scheduling

Rescheduling & Conflict Checks

Claims Management

Claim Summary

Claim Timeline

Create Claim

OASIS Assessments

New OASIS Assessment

OASIS-E Assessment

📋 M1800-M1870 — Functional Status

🧠 GG0100-GG0170 — Function & Cognition

🏥 M1000-M1036 — Clinical Status

QAPI & Compliance

Performance Improvement Projects

Recent Incidents

Survey Readiness — CoPs

Dashboard

Patient Census

Risk and Follow-up Queue

Patient Onboarding

EVV Tracking

Care Plans (485/486)

Create Care Plan

CMS-485 Generated

Care Plan Signature Routing

Medication Management

Remittance Advice

Settings

Agency Information

Operational Settings

Users & Access (This Agency)

Confirm Referral Acceptance

Decline Referral

Eligibility Verification

Verification Details

⚡ OASIS Validation Results

Submit OASIS for Review

PIP: Reduce Hospitalizations

Action Items

CMS-486 Medical Update

Patient Chart - Martha Johnson

Start Discharge Workflow

Schedule Visiting Nurse

Reschedule Visiting Nurse Visit

Visit Details

CLM-4821 — Martha Johnson

PDGM Grouping