Documentation Compliance Checker User Guide

1. Welcome

The Documentation Compliance Checker is the One Care Portal module for reviewing documentation before someone else does. Inside the portal it is labelled Documentation Intelligence, which is the name you will see on screen and in the steps below. You upload charts, service notes, contact notes, plans of care, or any other record as a PDF. The module compares each PDF with the review criteria your organization has written and flags possible documentation gaps, quoting the text it relied on and the page it found it on. A reviewer on your team then checks each flag against the source document and records what your organization decided.

Agencies use it for monthly chart audits, pre-billing documentation checks, supervisor quality reviews, and audit preparation. The line that appears on every screen sums up how it works: AI-assisted review. Human-controlled decisions.

What You Can Do

• Set up programs and criteria — write the checks that matter for each program or document type you review.
• Upload PDFs — one or many at a time, up to 20 MB each.
• Run AI analysis — each PDF is checked against the program's criteria in the background.
• Review flags beside the document — jump straight to the cited page and compare.
• Record decisions — confirm, dismiss, or mark each flag addressed, then complete, return, or escalate the review.
• Track and report — see what is waiting, which criteria are flagged most often, and export to CSV.

Key Terms

In short: a program holds criteria; an analysis checks one PDF against them and raises flags; a reviewer gives each flag a disposition and the document a final decision.

This guide covers Documentation Intelligence only. Separate guides are available for Case Management, the Care Module, and Billing Hub.

2. Getting Started

Opening the Module

1. Log in to your organization's One Care Portal. You land on the Service Overview dashboard.
2. Find the Documentation Intelligence card and click Open Documentation Intelligence.
3. The module opens on the Review Queue.

If you do not see the card, either the module has not been switched on for your organization or you have not been given a Documentation Intelligence role. The module is enabled for each organization by One Care Portal; roles are assigned by your organization's administrator. See Roles & Permissions.

Finding Your Way Around

Four links appear at the top of every Documentation Intelligence page:

The Review Queue and Review Insights are available to everyone with access. Upload and Programs & Criteria appear only for users who can make changes.

First-Time Setup

Nothing is pre-loaded. A new organization starts with no programs and no criteria, and nobody can upload until at least one program exists. Before your first upload:

1. Open Programs & Criteria and click New program (see Programs & Criteria).
2. Give the program a name and add at least one criterion.
3. Click Save program.
4. Go to Upload. The program now appears in the Program list.

3. Roles & Permissions

Your organization's administrator assigns Documentation Intelligence roles under Manage Users. There are two roles:

• Documentation Intelligence Access — full use of the module, including uploads, analysis, criteria, and decisions.
• Documentation Intelligence View Only — can read everything and export, but cannot change anything.
• Organization administrators have full access without needing either role.

View-only users do not see the Upload or Programs & Criteria links, and the analysis and decision buttons are hidden for them in the Review Workspace.

4. Programs & Criteria

Documentation Intelligence > Programs & Criteria

A program is the rulebook an upload is checked against. Most organizations create one program per kind of document they review, because a monthly contact note, a plan of care, and a daily attendance record each need different checks.

Creating a Program

1. Click New program.
2. Enter a Program name (required, up to 150 characters) and, if helpful, a Description.
3. Under Review criteria, fill in the first criterion (see the fields below).
4. Click Add criterion for each additional check. A program needs at least 1 criterion and can hold up to 100.
5. Click Save program.

Criterion Fields

Each criterion has a Criterion code, a Criterion title, a Category, a Severity (Low, Medium, or High), and Reviewer guidance. The guidance is the most important field: it is the instruction the AI follows.

Writing Good Reviewer Guidance

• One requirement per criterion. “Signature and date present” is easier to review, and to measure, than a criterion that bundles five checks.
• Say what to flag. Describe the gap: “Flag the note if it does not state…”
• Say what counts as acceptable. If a typed name with credentials is acceptable in place of a handwritten signature, say so.
• Use the words that appear in your documents. If your form says “Method of Contact”, use that phrase.
• Ask for gaps, not verdicts. Guidance such as “decide whether this note is compliant” does not work; the module is built to describe documentation gaps, and an analysis that returns a verdict is discarded.

Examples you can adapt. These are illustrations only; base your own criteria on the regulations, payer rules, and policies that apply to your organization.

Editing a Program

Select a program from the list on the left, make your changes, and click Save program. Use Remove to delete a criterion (the last remaining criterion cannot be removed).

If two people edit the same program at once, the second person to save sees “Someone changed this since you loaded it. The latest version is shown.” Review the latest version and make your change again.

Archiving a Program

Programs cannot be deleted. To retire one, open it and clear the Active: available for new uploads and analyses checkbox, then save. Archiving keeps existing documents, analyses, and decisions. Archived programs cannot receive new uploads or analyses, and they are shown as Archived in the program list and as “(archived)” in filters. Tick the checkbox again to reactivate.

5. Uploading Documents

Documentation Intelligence > Upload

The Upload page walks through three steps on one screen.

1. Select program. Choose the program whose criteria should be applied. Only active programs are listed. The page shows the criteria revision and the number of active criteria so you can confirm you picked the right one.
2. Add PDFs. Click PDF files and select one or more files. Each file appears in a list with its size.
3. Review and upload. Check the summary of program, criteria, and files, then choose one of the two upload buttons.

Upload and analyze stores each file and starts analysis immediately. Upload without analysis only stores the files, so you can analyze them later from the Review Queue.

File Requirements

• PDF only. Word documents, images, and spreadsheets must be saved or exported as PDF first.
• Up to 20 MB each. Split or compress larger files.
• File names up to 255 characters.
• One document per PDF. Every PDF is analyzed on its own. If you scan a whole chart into a single PDF, it is reviewed as one document.

Watching Progress

Each file shows a status as it moves through upload and analysis:

The statuses are Waiting, Uploading, Analyzing, Ready for review, Uploaded, not analyzed, and Failed. When every file has finished, an Open Review Queue link appears.

Upload Messages and What to Do

6. How Analysis Works

During an analysis the PDF is checked against every active criterion in its program, using the criteria as they stand at that moment. Analysis runs in the background: you can keep working, leave the page, or log out, and it carries on.

Analysis Statuses

A document is Not started, Analyzing, Analysis complete, or Analysis failed. The green “Analysis complete” badge means the step finished; it is not a judgment about the document.

Starting, Re-running, and Retrying

Open a document from the Review Queue. The button at the top right of the Review Workspace changes with the document's state:

• Analyze PDF — the document has never been analyzed.
• Re-run analysis — a result exists and you want a fresh one, usually after changing the program's criteria.
• Retry analysis — the last attempt failed or was interrupted.

Re-running creates a new analysis and leaves earlier ones in place. See Recording Decisions for what happens to decisions already recorded.

When an Analysis Fails

A failed analysis shows “The last analysis failed” with a reason. If an earlier analysis completed, it is still shown.

Most failures are temporary, and Retry analysis resolves them. A failed attempt never leaves a partial result behind.

7. The Review Workspace

Documentation Intelligence > Review Queue > open a document

The Review Workspace puts the source PDF on one side and the AI-generated review flags on the other, so every flag can be checked against the page it refers to. On a narrow screen the two sides become tabs named Document and Review Flags.

The top of the page shows the file name, program, who uploaded it and when, the analysis status, and review progress such as “2 of 5 flags reviewed”.

The Document Viewer

• Previous page / Next page, or type a number in the Page box, to move through the PDF.
• Zoom — Fit width, 100%, or 150%.
• Open opens the PDF in a new browser tab; Download saves a copy.

The AI Outcome

The summary at the top of the flags panel is tagged AI-generated and shows one of three outcomes:

The three outcomes are No issues flagged, Needs attention, and Not enough information. There is no score and no pass or fail result.

Below the outcome you can see when the analysis ran, who started it, and which criteria revision it used. Expand Criteria used in this analysis to see the exact criteria applied, even if the program has been edited since.

Reading a Flag

Only criteria that were flagged are listed, with at most one flag per criterion. Each flag shows:

• The criterion title and a severity badge (low, medium, or high).
• An explanation of the possible gap.
• A Page N button with the quoted evidence. Click it to jump the viewer to that page.
• A Suggested reviewer step.
• The current Human decision for the flag, which reads “Not reviewed yet” until someone records one.

Earlier Analyses

When a document has been analyzed more than once, an Analysis list appears with the Current analysis and each Earlier one. Earlier analyses are read-only: you can see their flags and decision history, but new decisions apply only to the current analysis.

8. Recording Decisions

Decisions are what turn AI flags into your organization's review record. They are made at two levels: each flag, then the document as a whole.

Step 1: Decide Each Flag

• Confirm flag — the gap is real.
• Dismiss flag — the flag is wrong or does not apply.
• Mark addressed — the gap was real and has been dealt with.

Each button opens a dialog where you can add a Reviewer comment (optional for flags, up to 2,000 characters). Click Record decision to save.

Step 2: Record the Final Decision

• Complete review — available once every flag has a decision. Until then you see “Review every flag before completing the review” with the number remaining.
• Return for follow-up — requires a comment explaining what needs to be fixed.
• Escalate review — requires a comment explaining why.

The final-decision dialog carries this reminder: “This records your organization's review outcome. It does not determine compliance, billability, fraud, or clinical or legal sufficiency.”

Changing a Decision and Viewing History

Decisions are never overwritten. If you record a different decision on the same flag or document, the new one becomes current and the earlier one stays in the record. Expand Disposition history on a flag, or Final decision history at the bottom, to see every decision with who made it, when, and their comment.

Decisions and Re-running Analysis

Re-running analysis starts a fresh review. Earlier decisions stay attached to the earlier analysis, and the document returns to “No decision” until the new flags are reviewed. Decisions cannot be recorded while an analysis is running.

If someone else acted on the document while you had it open, you see “This document changed since you loaded it. The latest version is shown; review it and try again.”

9. The Review Queue

Documentation Intelligence > Review Queue

The Review Queue lists your organization's uploaded documents, newest first, and shows what each one needs next.

Summary Tiles

The four tiles are Awaiting analysis, Needs human review, Ready for final decision, and Returned or escalated. Documents whose review is completed are not counted in a tile.

Columns

Filters

• Search file names — narrows the rows shown on the page.
• Program — all programs or one; archived programs are marked.
• Analysis and Human outcome — filter by status.
• Uploaded from / Uploaded to — a date range.

Exporting the Queue

Click Export CSV to download documentation-review-documents.csv. It contains one row per document with these columns: Document, Program, Uploaded, Uploaded by, Analysis status, Outcome, Findings, Unresolved findings, Current decision, and Decision date.

• The export follows the Program, Analysis, Human outcome, and date filters. The file-name search applies on the page only and is not applied to the export.
• Statuses appear in the file as short codes rather than the on-screen labels, for example completed, needs_attention, and approve / return / escalate.
• The export is limited to 1,000 rows.

10. Review Insights

Documentation Intelligence > Review Insights

Review Insights shows which criteria are flagged most often, how reviewers resolved them, and where review work is outstanding. Filter by Program and by upload date.

Summary Numbers

• Documents analyzed — documents with a completed analysis.
• Documents requiring attention — documents that still need flag review or a final decision.
• Unresolved flags — flags nobody has decided yet.

Panels

• Flag rate by criterion — the share of analyzed documents where each criterion was flagged.
• Reviewer dispositions — how many flags were Confirmed, Dismissed, Addressed, or are still Undecided.
• Outstanding review work — for each program, how many documents need human review and how many are ready for a final decision.

Criteria Detail

The table lists every flagged criterion with its Program, Severity, Flag rate, the number Confirmed, Dismissed, Addressed, and Undecided, and its Dismissal rate.

Exporting Insights

Click Export CSV above the table to download documentation-review-common-findings.csv, with the columns Program, Rule code, Criterion, Category, Severity, Documents flagged, Documents analyzed, Confirmed, Dismissed, Resolved, and Undecided. In the file, “Rule code” is the Criterion code and “Resolved” is the count shown on screen as Addressed.

11. Limits & Good Practice

What to Know Before You Rely on a Result

• PDF only, 20 MB per file. Each PDF is analyzed individually.
• Scanned documents. Text recognition (OCR) is not guaranteed. Clear, straight, typed scans give the best results; faint or handwritten pages may be missed or returned as Not enough information.
• Password-protected PDFs. Remove the password before uploading so the content can be read.
• Your criteria, not a rulebook. There is no built-in regulatory or payer rule library. The module checks what your criteria ask for and nothing else.
• One document at a time. Each PDF is reviewed on its own. The module does not compare documents with each other, so it will not detect a note copied from another file.
• No duplicate detection. Uploading the same file twice creates two separate documents.
• Standalone. It does not read from or update Case Management, the Care Module, Billing Hub, an EHR, or a clearinghouse.
• Records are kept. Documents, analyses, and decisions cannot be deleted or edited from within the module.

Good Practice

• Check every flag against the cited page before deciding. The quoted evidence is AI-provided text.
• Treat “No issues flagged” as “nothing flagged against our criteria”, not as proof that a document is compliant.
• Use comments to record why a flag was dismissed. That reasoning is what makes the review useful later.
• Review your criteria regularly, especially after a rule or policy change, and re-run analysis on documents still under review.
• Upload only what your organization's privacy and records policies allow, and give module access only to staff who need it.

12. Common Workflows

Workflow 1: Monthly Chart Audit

1. Export or scan the charts in your audit sample to PDF, one PDF per chart or per document, with clear file names.
2. Go to Upload, select the program, add the PDFs, and click Upload and analyze.
3. When the files show Ready for review, click Open Review Queue.
4. Open each document with Start review, check each flag against its cited page, and confirm, dismiss, or mark it addressed.
5. Record the final decision: Complete review, Return for follow-up, or Escalate review.
6. Open Review Insights, filter to the audit period, and click Export CSV for your audit file.

Workflow 2: Pre-Billing Documentation Check

1. Before notes are handed to billing, export the period's service notes as PDFs.
2. Upload them to the program that holds your billing-related documentation criteria.
3. In the Review Queue, work the Needs human review documents first.
4. Return for follow-up any note with a confirmed gap, with a comment saying what must be corrected.
5. Once the author has corrected the note, upload the corrected PDF as a new document and review it.

Workflow 3: Supervisor Quality Review

1. Upload a sample of each staff member's notes, using file names that identify the author.
2. Review the flags and record decisions with comments.
3. Use Search file names in the Review Queue to pull up one person's documents for a supervision meeting.
4. Use Review Insights to see which criteria are flagged most often across the team, and plan training around them.

Workflow 4: Applying Updated Criteria

1. Open Programs & Criteria, edit the program, and click Save program. The revision number goes up.
2. New uploads use the new revision automatically.
3. For a document already analyzed, open it and click Re-run analysis. The workspace shows which revision each analysis used.
4. Review the new flags and record decisions on the current analysis.

13. Frequently Asked Questions

Does the Documentation Compliance Checker decide whether a chart or note is compliant?

No. It compares each uploaded PDF with the review criteria your organization wrote and flags possible documentation gaps, with the page where it found the evidence. A person on your team checks each flag against the source document and records the decision. It does not determine compliance, billability, fraud, or clinical or legal sufficiency.

What kinds of files can I upload?

PDF files only, up to 20 MB each. You can select several PDFs at once; each one is stored and analyzed as its own document. Export or scan charts, service notes, plans, and other records to PDF before uploading.

Does it work on scanned or handwritten documents?

It can, but text recognition (OCR) is not guaranteed. A scan that is faint, skewed, or handwritten may come back as Not enough information, or the analysis may miss details. Always check the cited page yourself.

Does it come with Medicaid, waiver, or payer rules built in?

No. There is no built-in regulatory or payer rule library. Your organization writes its own programs and criteria under Programs & Criteria, based on the rules and policies that apply to you.

Does it read our Case Management notes or billing records automatically?

No. It is standalone. It only reviews PDFs that someone uploads, and it does not read from or write to Case Management, the Care Module, Billing Hub, an EHR, or any other system.

If we change our criteria, what happens to documents we already reviewed?

Nothing changes for them. Saving a program creates a new criteria revision that applies only to future analyses. Earlier results keep the criteria they were run with. To apply the new criteria to an existing document, open it and click Re-run analysis.

Why is the Complete review button disabled?

Every flag in the current analysis needs a decision first. Confirm, dismiss, or mark each flag addressed, and the button becomes available. Return for follow-up and Escalate review are available at any time.

Who can see the documents we upload?

Everyone in your organization who has a Documentation Intelligence role, and your organization's administrators. Documents are not limited to the person who uploaded them, and they are never visible to other organizations.

Can I delete a document after uploading it?

Not from within the module. Uploaded documents, analyses, and decisions are kept as a record. If a file was uploaded by mistake, contact One Care Portal support.

14. Quick Reference

Need More Help?

Read the Documentation Compliance Checker overview for what the module is designed for, browse the other user guides, or contact support.