Health Systems and Provider Networks
Consistent oversightacross sites, programs,and payers.
Help clinical, utilization management, and quality teams review documentation, surface missing evidence, and prepare for payer review, with the criteria that apply to each service and site.
100%
Chart review coverage
Clinical, UM, and quality teams read the same chart for different reasons. Circle brings each reviewer the evidence they need, without rebuilding the record.
Reimbursement structure
Mixed models across service lines: cases, encounters, units, and per diem programs, each with its own payer rules.
Common criteria evaluated
- InterQual, MCG, and payer-specific criteria
- CMS Conditions of Participation
- The Joint Commission (TJC)
- CARF (medical rehabilitation and embedded behavioral health or SUD programs)
- State licensing
- Commercial and Medicare Advantage payer policies
How it works, in the daily work.
Built into every review.
Criteria by service and site
Distinct rules for acute, behavioral, outpatient, and specialty programs, with one view for leadership.
Admission and concurrent review
The clinical timeline and current justification prepared for UM before review deadlines.
Evidence before re-asking
What is already in the chart surfaced first, so clinicians get fewer repeat requests.
Clinical need versus placement delay
Active treatment and discharge barriers documented separately, so each team acts on the right problem.
Corrective action follow-through
Later encounters rechecked after an intervention to see whether the same gap returns.
Tracer and survey readiness
Care timelines assembled across encounters and handoffs for internal tracers and survey preparation.
Payer rules by product
Commercial, Medicare Advantage, and Medicaid requirements kept distinct rather than one blanket rulebook.
Works alongside EMR
Reads the systems each site already runs. Clinical decisions stay with qualified staff.
What customers have measured.
100%
Chart review coverage
1,000+
Insurance plan rulebooks ingested
2M+
Records processed
Explore further
Solution
Utilization Management
Authorizations and concurrent reviews, ready before the window closes.
Solution
Compliance and QA
Every active chart reviewed while the client is still in care.
Solution
Pre-Bill and Record Reviews
Documentation gaps caught before billing, and records ready for payer reviews.
Know what each payer expects. Act before revenue is at risk.
See how Circle fits alongside the systems already in place.
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