01 / GATHER
Bring the case together.
Bring only the source facts needed for the chosen workflow together around the same insured encounter.
Service intentApproval evidencePayer requirement
PROVIDER-SIDE REVENUE INTEGRITY
Keep insured revenue moving.
Move the exception. Keep the memory.
CareWeave gives billing and insurance teams one evidenced queue for the cases that still need human coordination.
Start with one service line and one payer workflow. Agree what CareWeave should catch, who owns the correction and how success will be measured before expanding.
CATCH IT WHILE IT CAN STILL BE FIXED
A denial is late feedback.
Missing evidence and mismatched approvals often exist before a claim is rejected. Start with one repeated, provider-fixable gap and surface it while the team can still change the outcome.
01 / BEFORE CARE
Make sure the approval still matches the care.
Compare the planned service with the approval on file before the mismatch reaches billing.
01 - GATHER THE FACTS
Imaging order
Hospital record · 09:12MRI brain · with contrast
Payer authorization
Approval letter · 09:18MRI brain · without contrast
Source and timestamp stay attached.
02 - FIND WHAT NEEDS ATTENTION
CareWeaveRevenue integrity
Checking the revenue matter
Patient and service matched
Authorization dates valid
Contrast outside approved scope
Revenue tied to this exceptionKES 24,000
Comparing the available facts…
03 - MOVE IT TO RESOLUTION
NEXT ACTION
Request an amended approval
The planned service does not match the approval.
Id
Assigned toInsurance desk
Awaiting updated evidenceThe exception stays open until it is resolved.
Reading order and approvalThe same revenue matter stays open as the facts change.
ONE ENCOUNTER. FOLLOWED TO OUTCOME.
The next action changes as the case changes.
An approval changes. The service changes. Evidence arrives. The payer responds. CareWeave keeps the next action and prior work attached to the same matter, then checks again.
02 / UNDERSTAND
Find what no longer lines up.
Compare the current case with the payer requirement that applies. See the mismatch, the supporting evidence and the reimbursement at risk.
Authorization does not cover contrast.
03 / RESOLVE
Give the team the next move.
Name the action and its owner. Recheck when evidence arrives. Close the exception only when the gap is actually resolved.
Requirement satisfied. Evidence verified.
THE GAP. THE EVIDENCE. THE NEXT MOVE.
A useful flag
should explain itself.
CareWeave shows what does not line up, why it matters, where the evidence came from, what value may be exposed and who can act.
REFERRAL EXCEPTIONCW-1043 · OPEN
The referral expires
before the procedure.
Coverage lapses 3 days before the booked service, so the claim would be filed against an expired authorisation.
- Referral valid through
- 30 Sep 2026
- Procedure scheduled
- 3 Oct 2026
- Uncovered gap
- 3 days
- Expected service value exposed
- KES 128,000
DECISION REQUIRED BY1 Oct · 9:58 AM17h 0m left
CASE OWNERInsurance deskEscalates to billing lead after 9:58 AM
Obtain a renewed referral before service.
Owner: insurance desk · Must be on file before 3 Oct 2026
Evidence: referral record (valid through 30 Sep 2026) + procedure booking (3 Oct 2026) · 2 records linked
PRACTICAL QUESTIONS
Fits the work
you already do.
ONE WORKFLOW. FOLLOWED TO OUTCOME.
Stop letting revenue disappear
into unresolved work.
Start with one workflow where your team already spends time chasing approvals, documents or payer corrections. Catch the issue earlier. Give it an owner. Verify that it was fixed.