careweave.

SOLUTIONS / REVENUE INTEGRITY

See where revenue
stops moving.

Hospital revenue moves through approvals, care, evidence, claims, payer responses, and payment. Start with one repeated exception your team already works by hand. CareWeave keeps its evidence, owner, next action and outcome together.

Explore the workflows How CareWeave connects

THE ENCOUNTER

The facts change over time.

Approvals, services, evidence and claim details do not always change together.

THE WORK

Revenue crosses several teams.

Insurance, clinical, records, billing and finance each hold part of the case.

THE GAP

Unresolved work becomes revenue risk.

CareWeave keeps the gap, evidence and next action attached to the revenue matter.

ONE OPERATIONAL GRAMMAR

Start narrow. Reuse only what proves useful.

Find the gap, prepare the next step and follow it until the outcome is clear.

01 / BEFORE CARE

Keep approval aligned with planned care.

A valid approval can still cover the wrong service, date or scope.

BEFORE CARE

Coverage & authorization

Check whether the planned service matches what the payer approved.

Denial preventionRevenue integrity

WHERE REVENUE GETS EXPOSED

Care changes, but the authorization does not change with it.

WHAT CAREWEAVE CHECKS

  • Coverage against the planned service.
  • Approved service, scope and dates against the current booking.
  • Changes that should trigger another authorization check.
EXAMPLE

MRI brain with contrast is scheduled. The approval on file is for MRI brain without contrast.

NEXT MOVE

Request an amended approval before service.

Usually owned by
Insurance / authorization desk
Close when
The updated approval matches the current service.

BEFORE CARE

Referrals & deadlines

Keep expiry dates and renewal work attached to the encounter.

Denial preventionException management

WHERE REVENUE GETS EXPOSED

The referral was valid when the patient was booked, but the service date moved beyond it.

WHAT CAREWEAVE CHECKS

  • Referral and authorization validity against the service date.
  • Renewals that need action before a deadline.
  • Booking or service changes that should reopen the check.
EXAMPLE

A referral expires on 24 Sep. The procedure was rescheduled to 27 Sep.

NEXT MOVE

Obtain a renewed referral for the new date.

Usually owned by
Scheduling / insurance desk
Close when
The replacement referral covers the current service date.

02 / BEFORE SUBMISSION

Make the claim match the encounter.

Care can be fully documented while the claim still carries missing or inconsistent information.

BEFORE SUBMISSION

Documentation integrity

Find supporting evidence before the claim depends on it.

Claim readinessDocumentation integrity

WHERE REVENUE GETS EXPOSED

The evidence exists, but it is missing from the claim workflow or linked to the wrong encounter.

WHAT CAREWEAVE CHECKS

  • Required evidence against the service being claimed.
  • Whether records are final and linked to the correct encounter.
  • Missing information that still needs human review.
EXAMPLE

The radiology report is signed in the clinical record but missing from the claim packet.

NEXT MOVE

Link the verified report to the claim.

Usually owned by
Billing / records / clinical team
Close when
The required evidence is present and matched to the service.

BEFORE SUBMISSION

Claim readiness

Check the claim against what was approved and what actually happened.

Claim readinessRevenue integrity

WHERE REVENUE GETS EXPOSED

Authorization, care, documents and claim details no longer describe the same encounter.

WHAT CAREWEAVE CHECKS

  • Claim details against approved and delivered care.
  • Supporting evidence required before submission.
  • Tariff or benefit information that remains inconsistent or uncertain.
EXAMPLE

The service changed during care, but the claim still reflects the original authorization.

NEXT MOVE

Resolve the mismatch before submission.

Usually owned by
Claims / billing team
Close when
The claim, evidence and approved service agree.

03 / AFTER PAYER RESPONSE

Turn the payer response into the next action.

Returns, reductions and partial payments should become owned work, not disappear into follow-up.

AFTER PAYER RESPONSE

Returns & corrections

Connect the payer response to the evidence and correction it requires.

Denials managementA/R follow-up

WHERE REVENUE GETS EXPOSED

The payer response sits in one place while the evidence needed to resolve it sits somewhere else.

WHAT CAREWEAVE CHECKS

  • The payer reason against the affected claim detail.
  • Whether the requested evidence already exists.
  • Correction, resubmission and acknowledgement as separate states.
EXAMPLE

A claim is returned for a report that already exists in radiology.

NEXT MOVE

Attach the verified report and resubmit.

Usually owned by
Claims / billing team
Close when
The corrected submission is recorded and followed to the next response.

AFTER PAYER RESPONSE

Payment differences

Keep unexplained balances visible after payment arrives.

A/R follow-upPayment reconciliation

WHERE REVENUE GETS EXPOSED

The claim is marked paid, but the expected and received amounts do not agree.

WHAT CAREWEAVE CHECKS

  • Payer decision against the payment received.
  • Evidence behind adjustments or tariff differences.
  • Balances that still need finance or A/R follow-up.
EXAMPLE

The claim is marked paid, but the settlement is lower than expected and the difference is unexplained.

NEXT MOVE

Review the difference and raise a supported query where needed.

Usually owned by
Accounts receivable / finance
Close when
The difference is explained or the additional payment is matched.

USE CASES

Different workflows.
One revenue cycle.

Prevent avoidable leakage, keep unresolved revenue visible and learn where the same gaps repeat.

01

Denial prevention

Catch provider-fixable gaps before they become avoidable rework.

02

Revenue integrity

Keep approval, care, evidence and claim details aligned.

03

A/R follow-up

Turn payer responses and unresolved balances into owned work.

04

Workflow intelligence

See where the same revenue gaps keep recurring.

Start with one workflow your team already works by hand.

Measure what changes before expanding.