Read most medical necessity criteria closely, and you’ll find that a surprising amount of it hinges on timing. This month, Circle has become significantly more precise about the timing of documentation requirements.

Reviews now resolve exact date windows

Improved

Treatment plans should be developed within seven days of admission, and assessments should be updated every 30 days. A note should be signed within 24 hours of each session.

Now, reviews calculate the relevant date window before each question runs. They also recognize the date formats that appear across clinical records and handle recurring requirements throughout an entire treatment episode.

For instance, if a requirement states “each 30-day period since admission” on a 90-day stay, the review will now produce three separate answers, each evaluated against the correct period.

This precision is crucial when a requirement is time-bound. Circle can evaluate the documentation against the same window defined in the requirement, rather than treating the entire chart as a single period.

Two new triggers have been added: program start and projected discharge

New

Program start can now trigger a review when a patient enters a program, enabling teams to verify the documentation requirements that pertain to that level of care.

Similarly, the projected discharge date can trigger a review before the patient leaves, highlighting discharge planning requirements while there’s still ample time to complete them. 

In conjunction with admission and recurring cadence triggers, reviews can now be aligned more closely with the timing requirements specified by your payors and accreditors.

Trigger changes can now be reverted

New

If a change to a trigger doesn’t behave as expected, you can adjust it, review the results, and revert to the previous configuration in a single click.

This makes it easier to refine review automation without being constrained by every change you make.

Improvements

• Utilization review triggers now include level-of-care filters to run different reviews for levels of care such as residential, detox, PHP, IOP, and others. This ensures that the requirements align with the actual treatment provided to the patient.

• Even faster review processing is achieved by expanding questions and selecting documents earlier, thereby reusing chart data that has already been retrieved.

• Sharper EMR sync. Program stays now resolve by name rather than internal ID, and Sunwave can return admitted, discharged, and active patients in a single pass.

Fixes

• After a chart review is completed, generated appeal letters and summary deliverables remain visible.

• Reviews now consider the admission date instead of the program’s start date when determining the relevant review period.