Clinical updateRm 214 · Plan A · Update 3
Due todayChecked automatically before every review.
- MBI•••• ••• MK73Checking…
- PlanPlan A Medicare Advantage
- Auth on fileReview due today
For managed-care and MDS teams
Every auth. Every review. On time.
Auths pulled from every portal. MBI and eligibility checked. The payer’s form filled from the chart, every answer sourced. Levels and carve-outs checked daily. You review and send.
The insurance form fills itself out.
Every payer’s own form, as they print it. Each box is answered from the chart, and each answer shows the note it came from. Your nurse checks it and sends it.
PLAN A HEALTHSkilled Nursing Facility · Concurrent Review Request
Form CR-2Rev. 03/2026
Complete all sections. Attach supporting clinical documentation. Fax to Utilization Management.
A. Member and stay
Member ID
Admit date
Auth number
Facility
Facility fax
B. Clinical status
Primary diagnosis (ICD-10)
Skilled services this periodIV therapyPTOTSTWound careTrach care
BP
Pulse
SpO₂
IV / injectable medications
C. Function and therapy
ActivityPrior levelCurrent level
Ambulation
Transfers
Lower-body dressing
Toileting
Therapy minutes this week
Tube feeding
D. Discharge plan
Discharge plan
Est. discharge date
Barriers / DME needed
- Each plan’s own form, loaded once by us.
- If the chart doesn’t say it, the box stays blank.
- Never types over a nurse.
Every decision, one inbox.
Portals, faxes and your EHR, read for you and matched to the resident. No more logging into six sites.
- Payer portalsLogged in for you
- FaxRead and filed
- Your EHRAuths and AR comments
InboxAll matched to residents
- Rm 117No answer, 49 hWaiting on payer
- Rm 302Level 3 approvedBilling level updated
- Rm 108DeniedNOMNC started, last day Nov 14
- Rm 214Approved, 7 daysCovered through Nov 18
Know who is due before the payer asks.
Each update starts filled from the chart. Sent ones are watched. A payer quiet for 48 hours is flagged.
Due today2
Due tomorrow2
Sent1
Waiting on payer1
Rm 214Plan A · Update 3Filled 22/22
Rm 108Plan B · Update 2Filled 19/19
Rm 302Plan A · Update 5Filling…
Rm 117Plan C · Update 2Sent 46 h ago
Rm 225Plan B · Update 1Filling…
Rm 131Plan C · Update 4Sent 52 h ago
Paid at the level you care for.
Every night, each resident’s chart is read against their plan’s level rules. You see the level it supports, and the one item that would earn the next.
- Read from the MAR, TAR, notes and therapy minutes
- Every item shows where the chart says so
- Built from your own contracts
Rm 302 · Plan ANightly level check · 2:00 AM
$395a day
L1
L2
L3
L4
- IV antibioticsReading the chart…L2
- Wound vacL3
- Therapy 5+ daysL3
- Trach careL4
One item from Level 4Is trach care charted somewhere else?
Daptomycin 500 mg IVRm 214 · Plan B · priced from the MAR
Adding up doses…Nov 8
Nov 9
Nov 10
Nov 11
Nov 12
- DialysisBilled by the provider
- Wound vacPaid on top of the per diem
- Flu vaccinePaid on top of the per diem
Carve-outs, priced from doses given.
Drugs priced from what the MAR says was given, against what each contract carves out. Dialysis, wound vacs and vaccines found in the chart too.
- One report every morning at 10
- Per drug, per day or per month, as the contract says
Everything around the review.
Auth tracker
Every stay’s auths and its next review date.
Share with rehab
Send a section by email. A code opens it, nothing else.
UR meeting sheet
One building’s residents, ready to print.
Billing export
The month’s managed-care days, as a spreadsheet.
MBI and eligibility
Checked automatically, so a lapsed plan never surprises you.
Morning email
Levels and carve-outs to act on, by building.
Your contracts, loaded
We load each plan’s rates. You check them.
Your edits stay yours
The AI never types over a person.
See it on your own residents.
Leave your work email and we’ll walk you through your buildings’ auths and reviews.
Rather talk first? Book 20 minutes
Questions people ask
Is it HIPAA compliant?
Yes. We sign a business associate agreement before we touch resident data. Emails never name a resident, and idle sessions sign out on their own.
Where does the information come from?
Your EHR, the payer portals you already log into, faxes, and your therapy system. We pull the whole chart since the last review (notes, MAR and TAR, therapy, vitals, labs, orders) and check the MBI and eligibility, so nobody exports or re-types anything.
Does it send anything to the payer by itself?
No. It fills the form and shows the note behind each answer. A nurse reviews it, changes what they want, and sends it.
What if the chart doesn’t answer a question?
The box stays blank for the nurse. An answer whose quote can’t be found in the chart is dropped, never guessed.
Which payers and forms does it handle?
Any plan you work with. We load each payer’s form and your contracts, so you never set up a template.
What does it cost?
It is priced per building. Book 20 minutes and we will give you a number on the call.