Medicare Dashboard
Revenue cycle overview — February 2026
SentinelEdge AI Insights
3 items need attention · Updated 2 min ago
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2 claims approaching timely filing deadline
Martinez, R. and Garcia, M. have been in rejected status for 18 and 14 days respectively. Medicare timely filing requires resubmission within 30 days.
Review claims →
Avg days to payment trending above target
Current 16.2 days vs 14-day target. 6 claims in DDE Review are the bottleneck — consider batch corrections in WayStar.
View recommendations →
Acceptance rate improved to 94.3%
Up 2.1% from last month. The PCC scrub changes from January appear to be catching more errors before WayStar submission.
Claims Submitted
142
▲ 12% vs last month
Accepted Rate
94.3%
▲ 2.1% vs last month
Avg Days to Payment
16.2
▼ Target: 14 days
Open AR Balance
$284K
8 claims > 30 days
Claims Pipeline
EOM Review
PCC Scrub
WayStar
Submitted
DDE Review
Paid
Facility Performance Comparison
| Facility | Claims | Accept Rate | Avg Days to Pay | Open AR | AR Health |
|---|---|---|---|---|---|
Ashton Medical Lodge Rockwall, TX |
24 | 96.2% | 14.1 | $42,800 | |
Traymore Dallas, TX |
18 | 94.8% | 15.3 | $31,200 | |
Midland Medical Lodge Midland, TX |
15 | 91.4% | 18.7 | $38,950 | |
Cheyenne Medical Lodge Mesquite, TX |
14 | 95.1% | 14.8 | $28,400 | |
Princeton Medical Lodge Princeton, TX |
12 | 93.7% | 16.0 | $24,100 | |
Hillside Medical Lodge Gatesville, TX |
11 | 97.1% | 12.4 | $16,800 | |
Madison Medical Resort Odessa, TX |
13 | 89.2% | 21.3 | $52,600 | |
Senior Care of Wichita Falls Wichita Falls, TX |
10 | 94.0% | 15.9 | $22,300 | |
Sheridan Medical Lodge Burkburnett, TX |
9 | 95.6% | 13.8 | $18,200 |
EOM Census Check
Run detailed census report, validate CWF, and check for hospice/MSP issues.
Review Rejections
6 claims in T/R status in DDE need corrections in DDE or WayStar.
Appeals Queue
3 post-pay reviews pending. Documentation needed for PDPM support.
Recent Activity
835 payment posted — Medicare batch #4821, 18 claims, $47,820.00 applied to resident accounts.
Today, 9:14 AM — Jaime S.
Claim rejected — Resident Garcia, M. (MBI: 1EG4-TE5-MK72) put in "R" status. Reason: Invalid occurrence code.
Today, 8:47 AM — DDE System
WayStar scrub complete — 15 claims accepted, 1 rejected (missing attending NPI). Correction needed.
Yesterday, 4:32 PM — WayStar
Benefit exhaust alert — Resident Thompson, R. approaching Day 100. Added to Benefits & Appeals Specialist' Benefits Exhaust spreadsheet.
Yesterday, 2:15 PM — CBO Biller
Post-pay review initiated — Medicare probe on Resident Wilson, J. — PDPM documentation requested. Moved to ALD payer.
Feb 7, 11:20 AM — Appeals Specialist
Medicare Claims Queue
49 active claims across all stages
Active Claims
All
EOM Review
Submitted
Rejected
Pending Payment
⏰ Timely Filing
| Resident | Facility | Claim Period | PDPM / RUG | Amount | Status | Age | Assigned |
|---|---|---|---|---|---|---|---|
Martinez, Rosa MBI: 1EG4-TE5-MK72 |
Ashton Medical Lodge | 01/01 — 01/31 | ES2 | $12,840 | Rejected — DDE | 18d | Jaime S. ⚠ Correct & Resubmit |
Thompson, Robert MBI: 3KW9-AB2-HL45 |
Traymore | 01/01 — 01/31 | HDE2 | $15,220 | EOM Review | 8d | CBO Biller |
Chen, William MBI: 7PQ2-VN8-RT61 |
Midland Medical Lodge | 01/15 — 01/31 | CA1 | $8,445 | Submitted | 3d | CBO Biller II |
Johnson, Patricia MBI: 5TH8-KL3-WX29 |
Ashton Medical Lodge | 01/01 — 01/31 | PDE1 | $18,660 | Accepted | 5d | Jaime S. |
Williams, James MBI: 2DF6-MN4-YZ83 |
Cheyenne Medical Lodge | 01/01 — 01/20 | BA2 | $9,180 | WayStar Scrub | 6d | CBO Biller |
Davis, Eleanor MBI: 8GH1-QR7-UV54 |
Hillside Medical Lodge | 12/15 — 12/31 | ES1 | $6,920 | Paid | — | CBO Biller II |
Garcia, Miguel MBI: 4JK5-OP9-CD37 |
Princeton Medical Lodge | 01/01 — 01/31 | CA2 | $11,350 | T Status — DDE | 14d | Jaime S. ⚠ Correct & Resubmit |
Ramirez, Carlos MBI: 9AB3-CD7-EF18 |
Madison Medical Resort | 01/01 — 01/31 | PDE2 | $16,930 | Submitted | 4d | CBO Biller |
Baker, Dorothy MBI: 6GH2-JK5-LM94 |
Sheridan Medical Lodge | 01/01 — 01/31 | CA1 | $7,680 | EOM Review | 7d | CBO Biller II |
Nelson, Frank MBI: 2NP8-QR4-ST67 |
Senior Care of Wichita Falls | 01/05 — 01/31 | ES1 | $10,240 | Accepted | 5d | Jaime S. |
Wilson, Joseph MBI: 6RT3-UV8-WX42 |
Lexington Medical Lodge | 02/15 — 02/28 2025 |
ES1 | $14,320 | Rejected — DDE ⏰ Filing deadline: 16 days |
348d | CBO Biller ⚠ URGENT: Resubmit |
Anderson, Betty MBI: 8YZ1-AB6-CD95 |
Farmersville Healthcare | 03/01 — 03/31 2025 |
HDE1 | $11,780 | Submitted ⏰ Filing deadline: 47 days |
318d | Jaime S. |
End of Month Checklist
January 2026 close — Medicare claims preparation
Residents on Census
87
Across 12 facilities
CWF Discrepancies
4
Sent to BOM for correction
Day 100 Alerts
2
Added to Benefits Exhaust sheet
EOM Process Steps
-
Run Detailed Census ReportPull current month census from PCC for all Medicare residents across all facilities.
-
Run CWF for Each ResidentCompare CWF days against census to verify they match. Flag any discrepancies.
-
Check for Open Hospice EpisodesVerify no residents have open hospice episodes that would affect Medicare billing.
-
Check for Open MSP FilesVerify Medicare Secondary Payer status for all residents.
-
Document Discrepancies to BOM4 discrepancies found — add to Excel error sheet and send to facility BOM for correction. IN PROGRESS
-
Update Benefits Exhaust Spreadsheet2 residents approaching Day 100 — add to Benefits & Appeals Specialist' tracking sheet.
-
Clinical EOM Review CompleteConfirm MDS nurses have completed their end-of-month clinical review for each resident.
-
Ready for Claim CreationAll EOM checks passed. Claims can be created in PCC.
Appeals & Post-Pay Reviews
Medicare probe reviews and recovery tracking
Active Appeals
3
Pending documentation
Dollars at Risk
$38,450
Recovery amount if not overturned
YTD Appeal Success
78%
▲ 5% vs prior year
Active Post-Pay Reviews
| Resident | Facility | Claim Period | Recovery Amount | Status | Appeal Level | Owner |
|---|---|---|---|---|---|---|
Wilson, Joseph MBI: 6LM3-ST8-EF42 |
Ashton Medical Lodge | 11/01 — 11/30 | $14,200 | Docs Requested | Level 1 — Redetermination | Appeals Specialist |
Brown, Margaret MBI: 9UV7-WX1-GH68 |
Midland Medical Lodge | 10/15 — 11/14 | $16,750 | Under Review | Level 2 — QIC | Benefits & Appeals Specialist |
Anderson, Carl MBI: 1YZ4-AB6-IJ95 |
Cheyenne Medical Lodge | 12/01 — 12/31 | $7,500 | 835 Posted — ALD | Level 1 — Redetermination | Appeals Specialist |
Appeal Workflow
Denial Log
Medicare denial tracking and pattern analysis — Last 90 days
Total Denials (90d)
42
▲ 8 vs prior quarter
Denial Rate
5.7%
Industry avg: 8-10%
Dollars Denied
$128,400
$84K recovered
Recovery Rate
65.4%
▲ 4.2% vs prior quarter
Top Denial Reasons
1
CO-4 — Procedure Code Inconsistent
Procedure code inconsistent with modifier or modifier missing
11 claims
2
CO-16 — Missing Information
Claim lacks information needed for adjudication
8 claims
3
CO-29 — Filing Limit Expired
Timely filing limit for initial claim has expired
6 claims
4
CO-197 — Precertification Absent
Precertification/authorization/notification absent
5 claims
5
CO-50 — Non-Covered Service
Services deemed not medically necessary
4 claims
Denials by Facility
Madison Medical Resort
9 denials
10.8%
Midland Medical Lodge
7 denials
8.6%
Ashton Medical Lodge
6 denials
4.9%
Traymore
5 denials
5.4%
Princeton Medical Lodge
4 denials
6.5%
Cheyenne Medical Lodge
3 denials
4.2%
Senior Care of Wichita Falls
3 denials
5.8%
Sheridan Medical Lodge
2 denials
4.3%
Hillside Medical Lodge
2 denials
3.5%
Whitney Nursing & Rehab
1 denial
2.1%
Recent Denials
All
Open
Appealed
Recovered
Written Off
| Resident | Facility | Denial Code | Amount | Status | Filed | Owner |
|---|---|---|---|---|---|---|
Martinez, Rosa MBI: 1EG4-TE5-MK72 |
Ashton Medical Lodge | CO-4 Procedure code inconsistent |
$12,840 | Open — Correcting | Feb 10 | Jaime S. |
Garcia, Miguel MBI: 4JK5-OP9-CD37 |
Princeton Medical Lodge | CO-16 Missing information |
$11,350 | Open — Docs Needed | Jan 27 | Jaime S. |
Reeves, Sandra MBI: 3HK7-LP2-QW48 |
Madison Medical Resort | CO-29 Filing limit expired |
$9,880 | Written Off | Jan 22 | CBO Biller |
Cooper, Helen MBI: 8RT5-UV3-XY19 |
Midland Medical Lodge | CO-4 Procedure code inconsistent |
$14,200 | Appealed — Level 1 | Jan 18 | Appeals Specialist |
Phillips, Howard MBI: 5MN9-OP1-RS63 |
Madison Medical Resort | CO-197 Precertification absent |
$16,420 | Appealed — Level 1 | Jan 15 | Appeals Specialist |
Torres, Maria MBI: 7CD2-EF6-GH84 |
Traymore | CO-16 Missing information |
$8,640 | Recovered | Jan 10 | Jaime S. |
Mitchell, Eugene MBI: 2AB8-CD4-EF57 |
Cheyenne Medical Lodge | CO-50 Non-covered service |
$6,340 | Recovered | Jan 6 | Benefits & Appeals Specialist |
Denial Pattern Analysis
AI-detected trends in denial data
Madison Medical Resort denial rate is 2x the network average
10.8% denial rate vs 5.7% network average. 6 of 9 denials are CO-4 (procedure code) and CO-197 (precertification). This suggests a systemic issue with MDS coding or the facility's clinical documentation — recommend flagging for BOM review during next site visit.
View Madison denials →
CO-29 (timely filing) denials are 100% preventable
6 claims denied for timely filing in the last 90 days — $38,200 in lost revenue. These are process failures, not clinical issues. Automated deadline alerts in the claims queue could eliminate this category entirely.
View filing deadline claims →
Recovery rate improving — 65.4% and trending up
Appeals Specialist's appeal process is working. Level 1 redetermination success rate is 72%. Recommend documenting their workflow as a standard process across all facilities.
AR Aging Report
Medicare accounts receivable by aging bucket — All facilities
0 — 30 Days
$148,200
62 claims
52.2% of AR
31 — 60 Days
$78,400
24 claims
27.6% of AR
61 — 90 Days
$38,950
11 claims
13.7% of AR
90+ Days
$18,450
5 claims
6.5% of AR
AR Aging by Facility
All Buckets
90+ Days
60+ Days
| Facility | Total AR | 0-30d | 31-60d | 61-90d | 90+d | Distribution |
|---|---|---|---|---|---|---|
| Madison Medical Resort Odessa, TX |
$52,600 | $18,200 | $14,800 | $12,400 | $7,200 | |
| Ashton Medical Lodge Rockwall, TX |
$42,800 | $28,600 | $10,200 | $4,000 | $0 | |
| Midland Medical Lodge Midland, TX |
$38,950 | $14,200 | $12,600 | $8,150 | $4,000 | |
| Traymore Dallas, TX |
$31,200 | $22,400 | $6,800 | $2,000 | $0 | |
| Cheyenne Medical Lodge Mesquite, TX |
$28,400 | $19,800 | $5,600 | $3,000 | $0 | |
| Princeton Medical Lodge Princeton, TX |
$24,100 | $16,800 | $7,300 | $0 | $0 | |
| Senior Care of Wichita Falls Wichita Falls, TX |
$22,300 | $12,400 | $6,200 | $3,700 | $0 | |
| Sheridan Medical Lodge Burkburnett, TX |
$18,200 | $11,800 | $6,400 | $0 | $0 | |
| Hillside Medical Lodge Gatesville, TX |
$16,800 | $12,200 | $4,600 | $0 | $0 |
AR Aging Analysis
AI-generated insights on receivables
Madison Medical Resort has 38% of AR over 60 days
$19,600 sitting in 60+ day buckets. Primary drivers: 3 claims stuck in DDE corrections and 2 pending redetermination appeals. Recommend prioritizing batch corrections this week.
View Madison claims →
Hillside and Sheridan have zero 90+ day AR
These facilities consistently clear claims within 60 days. Their BOM-to-CBO communication workflow could be a model for other sites.
Resident Census
87 active residents across 12 facilities — Real-time census overview
Total Residents
87
Across 12 facilities
Medicare Part A
62
71% of census
Medicaid
25
29% of census
Day 80+ Alerts
4
Approaching benefit exhaust
Census by Facility
All Residents
| Resident | Facility | Payer | Admit Date | Benefit Day | PDPM | Next MDS Due | Physician |
|---|
Revenue Operations Workflow
11-step process map — Click any step for full detail
Ashton Medical Lodge
Rockwall, TX
Recent Claims
Current Residents
Active Issues
Facility Snapshot
Census Lookup
Search any resident across all 12 facilities — verify eligibility, benefit days, and payer status
👤 Rodriguez, Elena
✓ Active ResidentFacilityAshton Medical Lodge
Admit Date02/10/2026
PayerMedicare A
MBI1EG4-TE5-MK72
Benefit DayDay 3 of 100
PDPMHB2-CA1
MDS Due02/18/2026 (5-Day)
AttendingDr. Patel
Discharge HospitalBaylor Scott & White
Eligibility Checks
✓ Insurance Active
✓ 3-Day Stay Confirmed
✓ No Hospice Election
✓ No MSP on File
⚠ MDS Due in 6 Days
What This Tool Does
Census Lookup is a single-search tool that pulls everything about a resident in one place. Instead of checking PCC for demographics, CWF for benefit days, and insurance portals for eligibility — this combines it all. In production, it queries PCC and CWF in real-time. Use it when a family calls asking about their loved one's coverage, when billers need to verify benefit periods before claiming, or when intake needs a quick eligibility check during admission.
CWF Validator
Cross-check PCC census against CMS Common Working File — catch discrepancies before they become denials
Residents Checked
87
All facilities
Matched
83
95.4% match rate
Discrepancies
4
Needs resolution
Last Run
Today
02/12/2026 9:14 AM
⚠ Discrepancies Found (4)
| Resident | Facility | PCC Days | CWF Days | Variance | Issue | Status |
|---|---|---|---|---|---|---|
| Mitchell, Robert | Traymore | 45 | 42 | -3 days | CWF shows 3 fewer days — possible missed inpatient days at prior facility | Open |
| Nguyen, Thanh | Madison Medical Resort | 28 | 28 | Match | Open hospice election found in CWF — not documented in PCC | Under Review |
| Williams, Mary | Cheyenne Medical Lodge | 91 | 88 | -3 days | Benefit period boundary — may have rolled into new period | Open |
| Garcia, Luis | Princeton | 15 | 15 | Match | MSP file found — employer group health plan may be primary | Under Review |
What This Tool Does
CWF Validator automates the most painful part of end-of-month: comparing PCC census data against the CMS Common Working File for every Medicare resident. Today, the team does this manually — logging into DDE, running queries per resident, comparing days, checking for hospice elections and MSP files. This tool runs all those checks at once, flags discrepancies, and tells you exactly what's wrong. It catches issues before claims go out — preventing CO-4 and CO-29 denials that can take 30+ days to resolve on appeal.
835 Posting
Import Medicare remittance files, auto-match payments to claims, and flag variances
Payments This Month
$284,610
▲ $18.2K vs last month
Claims Matched
142
Auto-matched to PCC
Variances
8
Expected vs actual
Denials in 835
6
Routed to appeals
Recent Postings
Variances
Denials
Recent 835 Postings
| Resident | Facility | Claim # | Billed | Paid | Variance | Status |
|---|---|---|---|---|---|---|
| Adams, Patricia | Ashton Medical Lodge | FSHC-26-001847 | $4,218.40 | $4,218.40 | $0.00 | ✓ Posted |
| Brown, James | Traymore | FSHC-26-001832 | $3,891.20 | $3,891.20 | $0.00 | ✓ Posted |
| Chen, Wei | Madison Medical Resort | FSHC-26-001856 | $5,104.80 | $4,872.30 | -$232.50 | ⚠ Variance |
| Davis, Michael | Cheyenne Medical Lodge | FSHC-26-001819 | $4,567.00 | $0.00 | -$4,567.00 | ✕ Denied CO-4 |
| Evans, Ruth | Princeton | FSHC-26-001843 | $3,445.60 | $3,445.60 | $0.00 | ✓ Posted |
| Foster, Raymond | Ashton Medical Lodge | FSHC-26-001861 | $4,892.10 | $4,654.80 | -$237.30 | ⚠ Variance |
What This Tool Does
835 Posting handles Step 8 of the revenue operations — payment application. When Medicare processes a claim, they send an 835 Electronic Remittance Advice file. This tool imports that file, auto-matches each payment line to the corresponding resident and claim in PCC, and posts the payment. When the paid amount doesn't match what was billed, it flags the variance so the team can investigate. Denied claims are automatically routed to the Appeals workflow. Instead of manually reconciling each remittance line, the team reviews exceptions only — saving hours per posting cycle.
Foursquare Healthcare
Medicare RevOps — Monthly Executive Summary
January 2026 · Generated by SentinelEdge.ai
Key Performance Indicators
Claims Submitted
142
▲ 12% vs December
Acceptance Rate
94.3%
▲ 2.1% vs December
Avg Days to Payment
16.2
▼ Above 14-day target
Total Revenue Collected
$487,200
▲ 8% vs December
Open AR Balance
$284,000
6.5% in 90+ days
Denial Rate
5.7%
Below 8-10% industry avg
Facility Performance Rankings
Denial Summary (90-Day)
Total Denials
42
Dollars Denied
$128.4K
Recovered
$84K
Recovery Rate
65.4%
1
CO-4 — Procedure Code Inconsistent
11 claims
2
CO-16 — Missing Information
8 claims
3
CO-29 — Filing Limit Expired
6 claims
4
CO-197 — Precertification Absent
5 claims
5
CO-50 — Non-Covered Service
4 claims
AI Recommendations
⚡ SentinelEdge AI — Action Items for February
- Madison Medical Resort denial rate is 2x the network average (10.8%). Schedule BOM review to address systemic MDS coding issues. Estimated recoverable revenue: $18,000/quarter.
- CO-29 (timely filing) denials are 100% preventable — $38,200 lost in 90 days. Implement automated deadline alerts at 7, 14, and 21 days post-rejection.
- 2 residents approaching Day 100 benefit exhaust (Thompson, Anderson). Ensure social services coordination for discharge planning or payer transition.
- Hillside Medical Lodge and Sheridan Medical Lodge have zero 90+ day AR. Document their BOM-to-CBO communication workflow as the standard for other sites.
- Acceptance rate improved 2.1% after January PCC scrub changes. Continue monitoring — project 96%+ acceptance by Q2 if trend holds.
Admissions
Incoming residents · Insurance verification · Intake tracking
Pipeline
Facility Board
Intake Checklist
Pending Admissions
5
Across 4 facilities
Insurance Verified
3
60% verified
Portal Submissions
2
Awaiting review
Intake Emails
1
In mailbox queue
Avg Intake Time
1.4d
▼ 0.3d vs last month
Pending Admissions Pipeline
All 5
🌐 Portal 2
📧 Email 1
📄 Scan 1
✎ Manual 1
Select a pending admission above to view their intake checklist.
Welcome to FSHC RevOps
This guide will walk you through every section of the app so you can navigate confidently. Whether you're reviewing claims, managing admissions, or running end-of-month tasks — everything is covered here.
Jump to a Section
Dashboard
KPIs, alerts, and daily activity at a glance
Claims Queue
Track every claim from submission to payment
Admissions
New residents, intake pipeline, and verification
Knowledge Base
Policies, PDPM guides, and team contacts
How Each Section Works
1
Dashboard
Your daily command center
▶
The Dashboard is the first thing you see when you log in. It shows real-time KPIs across all 12 facilities:
- Active Claims — total claims currently in the pipeline
- Pending Amount — dollar value of outstanding claims
- Clean Claim Rate — percentage of claims accepted on first submission
- Avg Days to Payment — how quickly Medicare is paying
💡 Tip: Click any KPI card to drill into the details. The numbers update in real-time in production.
→ Go to Dashboard
2
Claims Queue
Every claim, every status, one view
▶
The Claims Queue is where billers spend most of their time. It lists every claim across all facilities with:
- Status filters — All, Pending, Submitted, Paid, Rejected, Denied
- Search — Find claims by resident name, MBI, or facility
- Sortable columns — Resident, Facility, Payer, Period, Amount, Status, Biller
💡 Tip: Rejected claims show a "Correct & Resubmit" link that opens a pre-filled correction form — no need to retype anything.
→ Go to Claims Queue
3
Admissions
Multi-channel intake, scan & auto-fill, public portal, and document storage
▶
Admissions supports four intake channels — Portal, Email, Scan & Auto-Fill, and Manual Entry — each tracked with color-coded source badges so staff instantly knows where an admission came from and how much work it needs.
- Pipeline — Every pending admission with verification status indicators (insurance, 3-day stay, PCC setup, MSP, hospice). Filter by source type using the chips above the list — Portal, Email, Scan, or Manual.
- Facility Board — Kanban-style board organized by stage: Pending Verification, Pending Documents, Ready for Billing, and Completed.
- Intake Checklist — Select a resident to see their 8-step intake checklist. Each step is interactive and trackable.
- Scan & Auto-Fill — Upload an intake packet, insurance card, photo ID, or hospital discharge summary. AI extracts the data and auto-fills the form. All scanned documents are stored and linked to the resident's record for compliance.
- Public Intake Portal — A family-friendly online form that can be sent via link before admission. Families complete demographics, insurance, emergency contact, medical history, and document uploads from their phone or computer. Data flows into the pipeline pre-filled — staff just verifies.
- Email Import — Pull referrals directly from the Foursquare Intake mailbox into the admissions pipeline.
- Document Storage — Every scanned or uploaded document (ID, insurance cards, discharge summaries, advance directives) is stored in HIPAA-compliant storage and permanently linked to the resident record for audits and compliance.
💡 Tip: Portal submissions and scanned admissions typically need 5 minutes of verification vs. 20+ minutes for manual entry. Check the source badges to prioritize your queue.
→ Go to Admissions
→ Go to Public Portal
4
EOM Checklist
End-of-month billing tasks, step by step
▶
Every month, the billing team runs through a series of tasks to close out the period. This view provides a structured checklist with:
- Tasks grouped by sequence (Census, CWF, Triple Check, Submission, etc.)
- Checkboxes to track completion
- Owner assignments so everyone knows their role
- A progress bar showing overall completion
💡 Tip: Work through these tasks top to bottom. Skipping steps (like CWF before Census) causes downstream errors.
→ Go to EOM Checklist
5
Appeals & Denials
Track denied claims and the appeals process
▶
Two related views for managing problem claims:
- Appeals — Shows claims currently in the appeals pipeline with levels (Redetermination, QIC, ALJ), deadlines, assigned owners, and dollar amounts at stake.
- Denial Log — A detailed log of every denial with CARC codes (CO-4, CO-16, CO-29, etc.), root cause, and resolution status. Use this to spot patterns — if the same denial code keeps appearing, there's a process issue to fix.
💡 Tip: The Denial Log includes a breakdown chart showing denial frequency by CARC code. If CO-16 is spiking, it usually means a claims data entry issue.
→ Go to Appeals
6
AR Aging & Census
Revenue tracking and resident counts
▶
- AR Aging — Breaks down outstanding accounts receivable by age bucket (0-30, 31-60, 61-90, 90+ days). Filterable by facility and payer. The goal is to minimize anything in the 60+ day buckets.
- Census — Real-time resident counts across all 12 facilities. Shows Medicare, Medicaid, Private, and VA breakdowns per facility. This is the data that drives everything else — if census is wrong, claims will be wrong.
💡 Tip: Compare Census numbers against CWF data every month to catch discrepancies before they become denied claims.
→ Go to Census
7
Workflow Map
The 11-step revenue operations, visualized
▶
The Workflow Map shows the entire FSHC revenue operations from admission to follow-up. Each step includes:
- The step name and responsible team member
- Systems used (PCC, WayStar, DDE, CWF)
- Specific tasks within each step
- Current bottlenecks highlighted in amber
→ Go to Workflow Map
8
AI Assistant & Knowledge Base
Get answers and look up policies instantly
▶
Two tools that are always available from anywhere in the app:
- AI Chatbot (bottom-right bubble) — Ask questions about claims, PDPM coding, billing procedures, timely filing rules, or team contacts. It understands FSHC-specific context and responds with actionable answers.
- Knowledge Base (sidebar under Resources) — A searchable library of articles covering Medicare billing basics, denial code guides, PDPM classification, PCC tips, and team contact info.
💡 Tip: Try asking the AI chatbot "What's the timely filing limit for Medicare?" or "How do I look up a claim in DDE?" — it's trained on FSHC's actual processes.
9
Notifications & Guided Tour
Stay on top of alerts and learn interactively
▶
- Notification Center (bell icon, top-right) — Shows urgent alerts, timely filing warnings, payment postings, and system updates. Badges indicate unread count.
- Guided Tour (graduation cap button, top-right) — A 16-step interactive walkthrough that highlights each section of the app with explanatory tooltips. Perfect for your first time or when training someone new.
💡 Tip: The guided tour takes about 3 minutes and covers every major feature. Highly recommended for new team members.
10
Public Intake Portal
Family-facing online form for pre-admission intake
▶
The Public Portal is a family-friendly online form that lets families complete intake paperwork before their loved one arrives at the facility. Staff sends a secure link via email or text — the family fills it out from their phone or computer.
- 6-Step Form — Resident information, emergency contact & legal authority, insurance details, medical history, document uploads (photo ID, insurance cards, discharge summary, advance directive), and review with e-signature.
- Auto-Populates the Pipeline — Submitted forms create a pending admission record automatically with a "Portal" source badge. Data flows directly into the intake form pre-filled — staff just verifies instead of typing.
- Shareable Link — Each link is tokenized, encrypted, and expires after 72 hours. Copy it from the portal view and send it to the family.
- Preview Form — Click the green "Preview Form" button next to the shareable link to see exactly what the family sees in a browser-style popup window.
- Impact — 80% less manual data entry, ~10 minute family completion time, 50% faster intake processing.
💡 Tip: Portal submissions come in with most verification steps already addressable. Check the Admissions Pipeline and filter by "Portal" to see which submissions are ready for quick review.
→ Go to Public Portal
11
Admin — Users, Roles & Audit Trail
Access control, permissions, and compliance logging
▶
The Admin section gives leadership and IT full control over who can access what, how roles are defined, and a complete log of every action taken in the system.
- Users & Permissions — View all team members with their role, facility access scope, and status. Filter by role type (Admin, Directors, Billers, Facility). Invite new users and manage access from one place. 12 active users across 9 roles covering all 12 facilities.
- Role Configuration — 5 pre-built roles with expandable permission grids: Administrator (full access), CBO Billing Director, CBO Biller, Appeals Specialist, and Facility BOM (read-only, facility-scoped). Each shows exactly which features they can and cannot access. Marked as draft — your team finalizes permissions during implementation.
- Audit Trail — Every action logged with timestamp, user, section, and details. Filter by Claims, Admissions, Admin, or Reports. This is your HIPAA compliance paper trail — who did what, when, and where.
- Facility-Scoped Access — Facility BOMs and read-only users only see data for their assigned building. The system enforces this automatically based on role configuration.
💡 Tip: The Admin section is only visible to users with Admin-level permissions. Facility BOMs and billers won't see it in their sidebar.
→ Users & Permissions
→ Role Configuration
→ Audit Trail
Public Intake Portal
A family-friendly online form that lets new residents (or their families) complete intake paperwork before arrival. Data flows directly into the admissions pipeline — no re-typing required.
How It Works
Send Link
Intake team emails or texts a secure link to the family before admission
Family Fills Out
Demographics, insurance, emergency contact, document uploads — all online
Auto-Populates
Data flows into the New Admission Intake form — pre-filled and ready for verification
Staff Verifies
Central Intake Team reviews, confirms insurance, and approves — 80% less data entry
Shareable Intake Link
🔗
https://intake.foursquarehc.com/admit/new?facility=ashton&token=x8k2m...
What the Family Sees
F
Foursquare Healthcare — Pre-Admission Form
Please complete this form before your loved one's admission. It takes about 10 minutes.
1
Resident Information
Basic demographics for the incoming resident.
Full Name
Date of Birth
SSN (last 4)
Primary Language
Marital Status
2
Emergency Contact & Legal
Who should we contact and who has decision-making authority?
Contact Name
Relationship
Phone
Email
Power of Attorney
Healthcare Proxy
3
Insurance Information
Primary and secondary insurance details.
Insurance Provider
Member ID / MBI
Group Number
Policy Holder
Secondary Insurance
4
Medical History
Current conditions, medications, and recent hospitalizations.
Primary Diagnosis
Current Medications
Allergies
Recent Hospital
Discharge Date
5
Document Uploads
Upload documents from your phone or computer.
Photo ID
Insurance Card (front & back)
Advance Directive
Hospital Discharge Summary
POA Documents
6
Review & Submit
Review all information, e-sign consent forms, and submit. A confirmation email is sent automatically.
E-Signature
Consent to Treat
HIPAA Acknowledgment
Financial Agreement
Expected Impact
80%
Less Manual Data Entry
~10 min
Family Completion Time
50%
Faster Intake Processing
🔒
Security & Integration
In production, the public portal uses encrypted cloud storage for document uploads, tokenized links that expire after 72 hours, and HIPAA-compliant data handling. Submitted forms create a pending admission record in the pipeline automatically — Central Intake Team gets notified and can verify data before it enters PCC.
Users & Permissions
Manage team access and facility assignments
Active Users
12
All systems active
Roles Defined
9
3 CBO + 6 Facility
Facilities Covered
12
100% of network
Pending Invites
2
Awaiting acceptance
Team Members
All
Admin
Directors
Billers
Facility
| User | Role | Facility Access | Last Active | Status | |
|---|---|---|---|---|---|
System Administrator admin@sentineledge.ai |
🛡 Administrator | All 12 Facilities |
Today, 2:14 PM | Active | Edit |
VP of Operations vp.ops@foursquarehc.org |
💼 VP Operations | All 12 Facilities |
Today, 11:45 AM | Active | Edit |
CBO Billing Director billing.director@foursquarehc.org |
💼 CBO Director | All 12 Facilities |
Today, 1:32 PM | Active | Edit |
Senior CBO Biller biller1@foursquarehc.org |
💲 CBO Biller | All 12 Facilities |
Today, 10:44 AM | Active | Edit |
CBO Biller II biller2@foursquarehc.org |
💲 CBO Biller II | All 12 Facilities |
Yesterday, 3:22 PM | Active | Edit |
Appeals Specialist appeals@foursquarehc.org |
⚖ Appeals Specialist | AshtonTraymoreCheyenne |
Yesterday, 1:10 PM | Active | Edit |
Ashton Medical Lodge — BOM bom.ashton@foursquarehc.org |
🏢 Facility BOM | Ashton Medical Lodge |
Feb 10, 9:33 AM | Active | Edit |
Traymore — MDS Coordinator mds.traymore@foursquarehc.org |
🏢 MDS Coordinator | Traymore |
Feb 11, 4:20 PM | Active | Edit |
Cheyenne — BOM bom.cheyenne@foursquarehc.org |
🏢 Facility BOM | Cheyenne Medical Lodge |
Feb 11, 2:18 PM | Active | Edit |
Madison — Facility Admin admin.madison@foursquarehc.org |
🏢 Facility Admin | Madison Medical Resort |
Feb 10, 11:05 AM | Active | Edit |
Pending — Princeton Medical Lodge newuser@foursquarehc.org |
📩 Pending | Princeton Medical Lodge |
— | Invited Feb 11 | Resend |
Pending — Midland Medical Lodge newbom@foursquarehc.org |
📩 Pending | Midland Medical Lodge |
— | Invited Feb 12 | Resend |
Role Configuration
Define permissions and feature access for each role
Total Roles
9
5 shown below
Permissions
8
Feature-level access controls
Admin Roles
1
Full system access
Read-Only Roles
4
Facility-level viewers
💼 CBO Billing Director
Operations oversight — 6 of 8 permissions
▶
✓
View Dashboard & KPIs✓
Edit Claims & Corrections✓
Manage Admissions & Intake✓
Run & Export Reports✓
Access Admin PanelManage Users & Invites
✓
View Audit TrailConfigure Roles
💲 CBO Biller
Daily claims processing — 4 of 8 permissions
▶
✓
View Dashboard & KPIs✓
Edit Claims & Corrections✓
Manage Admissions & Intake✓
Run & Export ReportsAccess Admin Panel
Manage Users & Invites
View Audit Trail
Configure Roles
⚖ Appeals Specialist
Denials and appeals — 3 of 8 permissions
▶
✓
View Dashboard & KPIsEdit Claims & Corrections
Manage Admissions & Intake
✓
Run & Export ReportsAccess Admin Panel
Manage Users & Invites
View Audit Trail
Configure Roles
Note: Appeals Specialists have read-only access to claims data and can only modify records within their assigned Appeals workflow. They can run denial and appeals reports.
🏢 Facility BOM / Read-Only
Facility-level dashboard — 2 of 8 permissions
▶
✓
View Dashboard & KPIsEdit Claims & Corrections
Manage Admissions & Intake
✓
Run & Export ReportsAccess Admin Panel
Manage Users & Invites
View Audit Trail
Configure Roles
Note: Facility BOMs and Read-Only users see only their assigned facility's data. Dashboard, census, and reports are filtered to their facility automatically.
Audit Trail
System activity log and change history
Actions Today
48
12 claims, 18 admissions, 8 reports, 10 other
Active Users Today
8
of 12 team members
Changes This Week
127
▲ 15% vs last week
Flagged Actions
0
All activity within norms
Activity Log
All
Claims
Admissions
Admin
Reports
Today, 2:34 PM
Claim Resubmitted Claims
Martinez, Rosa — MBI 1EG4-TE5-MK72 — Ashton Medical Lodge — Correction applied, resubmitted to Medicare DDE — Senior CBO Biller
Today, 1:58 PM
Claim Corrected Claims
Thompson, Robert — Traymore — Occurrence code 17 updated to match admission date — CBO Biller II
Today, 12:15 PM
Portal Submission Received Admissions
New intake via Public Portal — Cheyenne Medical Lodge — Auto-assigned to Central Intake Lead for review
Today, 10:22 AM
Monthly Report Exported Reports
January 2026 Summary — PDF format — All 12 facilities included — CBO Billing Director
Today, 9:45 AM
Admission Verified Admissions
Insurance eligibility confirmed — Medicare Part A active — Ashton Medical Lodge — Central Intake Lead
Yesterday, 4:47 PM
Timely Filing Alert Triggered Claims
Wilson, Joseph — Lexington Medical Lodge — Claim period 02/15-02/28/2025 — 16 days to filing deadline — System auto-alert
Yesterday, 3:20 PM
User Invited Admin
Role: Facility BOM — Princeton Medical Lodge — Invite sent to newuser@foursquarehc.org — Administrator
Yesterday, 2:12 PM
835 Payment Posted Claims
Batch #4821 — 18 claims, $47,820.00 applied — Chen, William (Midland) included — CBO Biller
Yesterday, 11:33 AM
Scan & Auto-Fill Completed Admissions
4 documents processed — ID, Insurance (front/back), Discharge Summary — Traymore — MDS Coordinator
Feb 10, 3:45 PM
AR Aging Report Generated Reports
Custom: 30/60/90+ days by facility — CBO Billing Director — $18,450 flagged in 90+ bucket
Feb 10, 1:15 PM
Role Permissions Updated Admin
CBO Biller role — Added "Run & Export Reports" permission — Administrator — Pending finalization
Feb 9, 5:02 PM
Denial Logged Claims
Medicare CARC CO-4 — Ashton Medical Lodge — Claim age 32 days — Assigned to Appeals Specialist