Health Systems and Provider Networks
Consistent oversightacross all sites, programs,and every payer.
Support clinical, utilization management, and quality teams as they review documentation, identify missing evidence, and get ready for payer and accreditation review using the right criteria for each service and site.
100%
Chart review coverage
Clinical, UM, and quality teams all review the same chart, but for different reasons. Circle gives each reviewer the evidence they need without having to rebuild 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 your daily routine.
Utilization review
Admission and continued-stay reviews prepared
Circle assembles the clinical course, notes what has changed since the last review, and shows what still needs the current level of care. This is checked against InterQual, MCG, or the plan's policy, so UM teams can prepare reviews before the payer's deadline.
Concurrent review
- Complete
Admission rationale
Clinical course linked to source notes
- Complete
Changes since last review
Treatment response summarized
- Review needed
Level of care criteria
Rationale for current vs lower level of care needed
- Review needed
Payer notification
Confirm channel and timeframe for this plan
- Late
Treatment plan update
Update past due for this stay
Built into every review.
Criteria by service and site
There are distinct rules for acute, behavioral, outpatient, and specialty programs, all shown in one view for leadership.
Admission and concurrent review
The clinical timeline and current justification are prepared for UM teams before review deadlines.
Check existing evidence before asking again
Circle shows what is already in the chart first, so clinicians get fewer repeat requests.
Clinical need versus placement delay
Active treatment and discharge barriers are documented separately, so each team can address the right issue.
Corrective action follow-through
Circle rechecks later encounters after an intervention to see if the same gap returns.
Tracer and survey readiness
Care timelines are assembled across encounters and handoffs to help with internal tracers and survey preparation.
Payer rules by product
Commercial, Medicare Advantage, and Medicaid requirements are kept separate, not in one blanket rulebook.
Works alongside EMR
Circle works with the systems each site already uses. Clinical decisions remain 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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