Audit Rules

32 read-only checks across 9 areas of CentralReach. These are the rules the local audit applies before scoring.

Authorization Setup

Whether authorizations can be tracked, paced and renewed on time.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Authorization manager assigned	Critical	Auth Manager	Without a named manager, no one owns renewal follow-up and lapsed authorizations are found after the fact.	Authorization Renewal, Executive Leadership
Authorization group populated	Critical	Authorization Group	The group identifier is how authorized hours roll up; missing groups undercount or misattribute utilization.	Authorization Utilization
Authorization end date present	Critical	Auth End Date	Expiring-authorization alerts and pacing depend entirely on the end date.	Authorization Renewal, Authorization Utilization
Authorized units entered	Critical	Authorized Units	Utilization percentage cannot be computed without an authorized quantity.	Authorization Utilization
Authorization linked to a payor plan	High	Payor Plan	Authorizations without a plan drop out of payor-level utilization and revenue analysis.	Payor Mix, Revenue Cycle

Whether billable activity maps to the right code and rate.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Service code present on authorization	Critical	Service Code	Missing service codes mean authorized hours cannot be matched to delivered hours.	Authorization Utilization, 97153 Productivity
Service code active and mapped	High	Service Code Mapping	Retired or unmapped codes fragment productivity and billing reporting.	Clinical Productivity, Revenue Cycle
Billable flag set correctly	Medium	Billable Flag	Non-billable time counted as billable inflates productivity and utilization.	Clinical Productivity, Staff Capacity

Core client attributes that every dashboard segments by.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Client office location set	High	Client Office Location	Clients without a location cannot be reported by site, so regional and clinic comparisons are incomplete.	Executive Leadership, Scheduling / Attendance
Client status current	High	Client Status	Discharged clients left active inflate caseload and capacity figures.	Caseload / Care Team, Staff Capacity
Funding source linked	Critical	Payor / Funding Source	Clients without a funding source fall out of payor mix and revenue reporting.	Payor Mix, Revenue Cycle

Provider attributes used to group, credential and compare staff.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Primary role assigned	Critical	Provider Primary Role	Providers without a role group incorrectly or are excluded from role-based productivity and supervision reporting.	97153 Productivity, 97155 Supervision, Staff Capacity
Provider office location set	High	Provider Office Location	Site-level staffing and utilization cannot be produced without a location.	Staff Capacity, Executive Leadership
Employment status and dates current	High	Hire / Termination Date	Departed staff without a termination date keep consuming modeled capacity.	Staff Capacity
Daily available hours configured	High	Daily Available Hours	Utilization is a percentage of available hours; without it, utilization is unmeasurable.	Staff Capacity, Clinical Productivity

Who is assigned to each client and in what capacity.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Care team provider role set	High	Care Team Provider Role	Role-based caseload balancing and supervision coverage require the assignment role.	Caseload / Care Team, 97155 Supervision
Supervising BCBA assigned	Critical	Supervising Provider	Supervision ratio and protocol-modification compliance key off the supervising provider.	97155 Supervision
Care team assignment active window	Medium	Assignment Dates	Stale assignments distort caseload counts per clinician.	Caseload / Care Team

Scheduled versus worked time, and the capacity behind it.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Scheduled hours resolvable	Critical	Scheduled Hours	Unknown scheduled hours make utilization, fill rate and capacity forecasting unusable.	Staff Capacity, Scheduling / Attendance
Worked hours resolvable	Critical	Worked Hours	Without worked hours, productivity and realization cannot be compared against schedule.	Clinical Productivity, Staff Capacity
Appointment status closed out	High	Appointment Status	Open or unconverted appointments distort attendance, cancellation and delivery reporting.	Scheduling / Attendance

Session documentation and data collection completeness.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Rendering provider on session	Critical	Rendering Provider	Delivered units without a rendering provider drop out of 97153 productivity.	97153 Productivity
Session data collection present	High	Session Data Collection	Sessions without collected data cannot evidence medical necessity or clinical progress.	Clinical Productivity, 97155 Supervision
Note signed and dated	High	Note Signed Date	Documentation compliance and billing readiness are measured from signature timing.	97155 Supervision, Revenue Cycle
Place of service recorded	Medium	Place of Service	Telehealth versus in-clinic analysis is impossible without it.	Scheduling / Attendance, Clinical Productivity

Whether clinical programming is current and measurable.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Active goals present for active clients	High	Client Goals	Clients in service without active goals cannot show progress in clinical reporting.	Clinical Productivity
Goals updated recently	Medium	Goal Last Data Date	Stale goals suggest data collection has stopped, which payors treat as a documentation gap.	Clinical Productivity, 97155 Supervision
Targets linked to programs	Medium	Target / Program Link	Unlinked targets break mastery and progress roll-ups.	Clinical Productivity

The keys behind revenue cycle, collections and payor mix.

Rule	Severity	Field checked	Why it matters	Dashboard impact
Payor plan on claim	Critical	Payor Plan	Claims without a plan are excluded from payor mix and contracted-rate comparison.	Payor Mix, Revenue Cycle
Payment posted date captured	Critical	Payment Posted Date	Aging buckets and cash velocity are computed from posting date.	Payments / Collections, Revenue Cycle
Claim status mapped	High	Claim Status	Denial and rework reporting is incomplete when statuses are unmapped.	Revenue Cycle
Adjustment reason recorded	High	Adjustment Reason	Revenue leakage root cause cannot be analysed without CARC/RARC reasons.	Payments / Collections