HOW CHARTTRACE WORKS
From documentation.
To an automated
workflow.
DOCUMENTED → AI PROPOSAL → RULE DETERMINED → AUTOMATION → HUMAN EXCEPTIONS / FINAL RELEASE.
ChartTrace is being built to do the routine work. People handle genuine exceptions and final release, not every recommendation.
Documentation enters.
Clinical/source documentation and resident, facility, payer and coverage context enter the intended workflow. Synthetic inputs are proven; automatic production ingestion and EHR integrations are being built.
Available inputs confirmed during evaluation.
Find evidence. Keep the source.
AI extracts literal statements with their source location. This is evidence for a proposal, not authority to invent missing facts.
“Staff provided verbal cues only; no physical assistance was needed.”
Oral hygiene
Self-care · Illustrative source excerpt
Resident completed toothbrushing while seated at the sink.
The oral-hygiene activity was completed.
Propose the routine work.
AI proposes coding and billing work from the documented evidence. This synthetic oral-hygiene candidate still needs rule validation and assessment context; it is not a released result.
EvidenceVerbal cues only · line 02
↳Rule basisSupervision or touching assistance
≡Open questionUsual performance / assessment window
!Determine what the rules allow.
Effective-dated deterministic rules govern mechanical billing truth where supported. AI cannot override them. Missing authoritative evidence or an applicable rule blocks progression.
Documented observation→Section GG
Applicable rule context→04Candidate only
The excerpt describes one observation. A qualified reviewer must establish usual performance across the applicable assessment window before a determination is approved.
CMS Section GG reference ↗Illustrated CMS RAI reference: v1.20.1 · effective October 1, 2025. Each determination requires its applicable rule version and effective date.
Apply SNF and claim logic.
Supported MDS/PDPM processing, official CMS FY2026 HIPPS grouping for supported synthetic vectors, and claim construction/scrubbing primitives form part of the platform. They do not establish comprehensive production code-set or payer coverage.
SNF-specific reimbursement intelligence.
- 01Supported MDS / PDPM inputs
Evidence-backed assessment processing for the supported scope.
- 02Official CMS FY2026 HIPPS grouping
Authoritative grouper results for supported synthetic vectors.
- 03Claim construction and scrub primitives
Building blocks for claim logic and validation, with human review and provenance.
A single oral-hygiene excerpt cannot establish a complete HIPPS result. Required assessment inputs and applicable versions must be established.
Automate the routine. Route the exception.
Supported routine work advances automatically without item-by-item approval in the intended production model. True judgment reaches an expert; missing information blocks; external-party dependencies remain tracked separately.
ChartTrace does the routine work.
No approval click on every item.
A qualified person reviews and releases the claim or batch before transmission.
Supported routine work advances
Sufficient literal evidence and authoritative, effective-dated rule support establish a supported routine result. Confidence alone is not enough.
ChartTrace is designed to process and advance this routine work automatically. A coder does not approve each item. Final claim or batch release still requires a qualified human.
Automatic processing · no item-by-item approvalA genuine exception
Clinical or coding judgment, conflicting evidence or true ambiguity prevents a safe mechanical determination.
Route the unresolved decision to a qualified expert. Their resolution returns through applicable validation; routine supported work continues without joining this queue.
Expert attention where judgment is requiredRequired support is absent
Required documentation, literal evidence or authoritative data cannot be established. There is no defensible basis to advance.
Fail closed. Keep the missing requirement visible and hold the item until it is supplied and validated. Do not guess or substitute AI confidence for authority.
Blocked until required information is establishedAn outside response is needed
A payer, provider or other external party must supply information before the work can continue.
The intended workflow tracks the dependency and keeps it distinct from an expert-judgment task, reducing repeated manual status checking. Live payer connections are not established.
Dependency tracked · resume when resolvedRoutine work and exceptions resolved
Required routine processing, validation and exception resolution are complete for this conceptual claim or batch.
Present the release-ready work and its evidence/rule provenance to an authorized person. Ready is a review state; it is not approval and does not permit automatic transmission.
Awaiting a qualified human’s final decisionExplicit final authority
A qualified human has reviewed the completed claim or batch and explicitly authorized release in the intended operating model.
Retain the human release action with literal evidence, rule version and effective date before the downstream transmission workflow. This illustration releases or transmits nothing.
Human authorization recorded · before transmissionSelect a state to inspect it. Qualitative illustration only: item counts and branch sizes do not represent measured volumes or automation rates. No patient data or claim transmission.
Resolve exceptions. Authorize release.
A qualified expert resolves genuine exceptions. After routine work and exceptions are complete, the claim or batch becomes ready for final review; a qualified human must explicitly release it before transmission. The synthetic controls below illustrate one exception decision, not a claim release.
Your biller.
Your judgment.
Try a review action on the fictional example.
Awaiting human review. An example approval assumes the assessment context has been confirmed.
See the resulting trace ↓Continue with a defensible record.
Retain literal evidence, rule version, effective date and human decision as the workflow continues. The downstream production lifecycle below is being built and is not a live submission or payment service.
- SourceSNF note · line 02
- EvidenceVerbal cues only
- Rule / versionCMS Section GG · RAI v1.20.1
- Effective dateOctober 1, 2025
- Recommendation04 · candidate
- Human actionAwaiting reviewer
No claim is submitted by this demonstration.
- Claim generationUB-04 / 837I
- SubmissionClearinghouse connectivity
- Acknowledgements999 / 277CA lifecycle
- Remittance835 processing
- Denials / rejectionsCorrection and rebill
- ReconciliationExpected vs. paid → A/R / underpayment recovery → resolution
These are the production lifecycle being built, not live services. Claim construction/scrubbing primitives have been demonstrated synthetically; production generation, transmission and downstream processing remain unfinished.
THE ARCHITECTURE MATTERS
AI proposes.
Rules determine.
Automation advances.
Humans authorize.
An automated operating layer for SNF billing, coding and RCM. Supported routine work progresses without individual approvals. Experts resolve judgment exceptions; missing information and external waits stay distinct. A qualified human controls final release before the downstream cycle continues.
ChartTrace is in commercial validation. Confirm available inputs, rule coverage and production scope during early-access evaluation. Compare supporting documentation examples and review working facility pricing.