Manual review
Admissions, clinical, and finance read every packet by hand.
- Time per packet: ~15-30 minutes of staff review.
- Coverage: Whatever the on-call reviewer remembers to check.
- Payer risk: Verified against payer portal manually, often after acceptance.
- MA authorization: Caught when prior auth is rejected, not before.
- Documentation gaps: Discovered during care, not before saying yes.
- Margin visibility: Spreadsheet-based, separate from clinical review.
- Consistency: Varies by reviewer, shift, and packet quality.
- EHR integration: N/A. Runs on whatever the on-call reviewer manually pulls from PCC, MatrixCare, or the inbox.
- Compliance posture: Strong. Humans on every decision, no automation surface.
Best fit: Low packet volume, experienced single-reviewer team, no tooling appetite right now.