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Platform · 03 · Case management

Concurrent reviews on schedule.
Justified from the chart.

Every authorization carries its review schedule, set by the payer contract. MedFlo drafts each justification from therapy and nursing notes, your case managers review it, and authorized days stay in view.

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ReviewsAll buildings · this week
ResidentPayerAuthorized throughNext reviewStatus
L. Brooks, 69Medicare Advantage PPOSep 16TodayDue today
R. Morales, 78Medicare Advantage HMOSep 19Sep 18Draft ready
A. Singh, 88Managed MedicaidSep 30Sep 23Submitted
J. Keller, 82Commercial PPOSep 24Sep 21Scheduled
T. Nguyen, 76Original Medicare → MA—Needs authPlan change
Where it sits in the journey

Picks up the approval. Keeps coverage honest.

Approvals arrive from pre-authorization, review cadence comes from contracts, and plan changes after admission come from payer change detection. Authorized days carry forward to billing.

Fed byPre-authorizationContractsPayer change detection
Case management
FeedsBilling · coming soon
What it does
Reviews on cadenceConcurrent reviews scheduled against each authorization, per the payer contract.
Justifications draftedDrafted from therapy and nursing notes, then reviewed by your team before anything is sent.
Authorized days trackedApproved dates and days remaining on every resident, in one list.
Plan changes surfaceWhen coverage changes after admission, the resident appears here with what it means.
Schedule

Every review, on the payer's schedule

The review calendar is built from the authorization dates and the cadence in your payer contract, so the next review is never a guess and authorized days never run out unnoticed.

R. Morales, 78Medicare Advantage HMO
Authorized Sep 13 – Sep 19Day 5 of 7
Sep 13Initial authorizationApproved
Sep 18Concurrent reviewDraft ready
Sep 25Concurrent reviewScheduled
Cadence from contract: every 7 daysp. 11
Clinical justificationDraft · for review

Resident continues IV vancomycin via PICC through day 14 MAR, Sep 17. Wound VAC changed three times weekly; wound bed granulating, measurements decreasing Wound note, Sep 16. PT: sit to stand with moderate assistance, gait training with rolling walker PT note, Sep 17.

Sources: therapy notes, nursing notes, MAREdit and approve →
Justifications

Drafted from the notes, finished by your team

MedFlo drafts the clinical justification from therapy notes, nursing notes and the MAR, with each statement tied to its source. Case managers edit and approve; nothing goes to the payer without a person signing off.

Plan changes

Coverage changes land where they can be handled

When payer change detection finds a plan switch, the resident shows up in case management with the new plan, its network status and the authorization and review rules from the contract.

From payer change detectionT. Nguyen, 76Original Medicare → Medicare Advantage HMO · effective Oct 1
AuthorizationNow requiredStart request
Network2026 MA agreementIn network
ReviewsEvery 7 days per contractScheduled
Skilled daysTracked under the new planReset
Connected in the journey
Pre-authorizationWhere the authorization starts.ContractsReview cadence and authorization rules.Payer change detectionPlan changes after admission.

Start with admissions.
Grow into the whole journey.