Fictional demo · Cedar Harbor Recovery All people, records and activity are synthetic. Program & walkthrough →

Mindful Auditor · Synthetic local desk · 2026-10-08

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Auditor settings

Synthetic configuration. All production answers, agreements and vendor tests remain phase 9 gates.

Local configuration

Configuration JSON

{
  "timezone": "America/New_York",
  "reviewMode": "mindful",
  "policies": {
    "identity": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "medications": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "payer": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "dates": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "frequency": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 3,
      "unit": "business-days"
    },
    "returned": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "approval": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "billing": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 3,
      "unit": "business-days"
    },
    "denial": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 3,
      "unit": "business-days"
    },
    "flow": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "supervision": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 1,
      "unit": "business-days"
    },
    "units": {
      "version": "synthetic-1",
      "enabled": true,
      "days": 3,
      "unit": "business-days"
    }
  },
  "assignments": [
    {
      "staffId": "S-01",
      "position": "author",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-02",
      "position": "author",
      "clients": [
        "*"
      ],
      "active": true,
      "supervisorId": "S-05"
    },
    {
      "staffId": "S-03",
      "position": "compliance",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-04",
      "position": "approver",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-05",
      "position": "clinical-director",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-06",
      "position": "program-director",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-07",
      "position": "ceo",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-08",
      "position": "intake",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-09",
      "position": "prescriber",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-10",
      "position": "nurse",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-11",
      "position": "ur",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-12",
      "position": "billing",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-13",
      "position": "hr",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-14",
      "position": "peer",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-15",
      "position": "administration",
      "clients": [
        "*"
      ],
      "active": true
    },
    {
      "staffId": "S-16",
      "position": "author",
      "clients": [
        "*"
      ],
      "active": true
    }
  ],
  "questions": {
    "1": {
      "status": "synthetic",
      "value": "Proceed as written"
    },
    "2": {
      "status": "synthetic",
      "value": "Checking only"
    },
    "3": {
      "status": "synthetic",
      "value": "After the pilot"
    },
    "4": {
      "status": "synthetic",
      "value": "All \"rule\"-method checks on; AI checks on in review-queue mode"
    },
    "5": {
      "status": "synthetic",
      "value": "None"
    },
    "6": {
      "status": "synthetic",
      "value": "—"
    },
    "7": {
      "status": "synthetic",
      "value": "Face sheet or client card; diagnostic assessment; prescriber's order or med list; ASAM assessment plus current authorization"
    },
    "8": {
      "status": "synthetic",
      "value": "2.1 and 2.5"
    },
    "9": {
      "status": "synthetic",
      "value": "All DocTypes in §6.1"
    },
    "10": {
      "status": "synthetic",
      "value": "§9.1 defaults"
    },
    "11": {
      "status": "synthetic",
      "value": "§9.1 defaults"
    },
    "12": {
      "status": "synthetic",
      "value": "§9.1 defaults"
    },
    "13": {
      "status": "synthetic",
      "value": "alerts-out"
    },
    "14": {
      "status": "synthetic",
      "value": "Unknown → link-only"
    },
    "15": {
      "status": "synthetic",
      "value": "§9.3 placeholders"
    },
    "16": {
      "status": "synthetic",
      "value": "Nightly; active clients plus 12 months of discharged"
    },
    "17": {
      "status": "synthetic",
      "value": "Weekly to Clinical Director, monthly to CEO, staff see their own"
    },
    "18": {
      "status": "synthetic",
      "value": "Door 3 bundle plus door 2 reports"
    },
    "19": {
      "status": "synthetic",
      "value": "Door 3 bundle plus door 2 reports"
    },
    "20": {
      "status": "synthetic",
      "value": "—"
    },
    "21": {
      "status": "synthetic",
      "value": "—"
    },
    "22": {
      "status": "synthetic",
      "value": "—"
    },
    "23": {
      "status": "synthetic",
      "value": "in-house, monthly"
    },
    "24": {
      "status": "synthetic",
      "value": "approver = assigned assessing clinician; 2 business days"
    },
    "25": {
      "status": "synthetic",
      "value": "none (rule elements only)"
    },
    "26": {
      "status": "synthetic",
      "value": "the five Cardinal Care MCOs plus fee-for-service, sourced fields only"
    },
    "27": {
      "status": "synthetic",
      "value": "the five Cardinal Care MCOs plus fee-for-service, sourced fields only"
    },
    "28": {
      "status": "synthetic",
      "value": "legal deadline only (one business day)"
    },
    "29": {
      "status": "synthetic",
      "value": "empty until a cited row exists"
    },
    "30": {
      "status": "synthetic",
      "value": "hold-for-compliance (cannot be turned off)"
    },
    "31": {
      "status": "synthetic",
      "value": "off"
    },
    "32": {
      "status": "synthetic",
      "value": "off"
    },
    "33": {
      "status": "synthetic",
      "value": "on for the CEO in the demo"
    },
    "34": {
      "status": "synthetic",
      "value": "record the decision on the outcome line"
    },
    "35": {
      "status": "synthetic",
      "value": "Unconfirmed until written answer and golden sample"
    },
    "36": {
      "status": "synthetic",
      "value": "Tokenized role only; no login stored"
    }
  },
  "billing": {
    "cycleDays": 3,
    "warningDays": 30,
    "unitWarningPercent": 80,
    "feeSchedule": {},
    "billableServices": []
  },
  "notifications": {
    "enabled": true,
    "quietStart": 18,
    "quietEnd": 8,
    "dailyCap": 8,
    "urgentBypassesQuiet": true
  }
}

Client questions · 36

Question	Topic	State
1	Is the summary right?	synthetic
2	Anything the agent should draft?	synthetic
3	Appeal and audit tools from the first design	synthetic
4	Which checks in version 1	synthetic
5	Other must-match / must-be-there items	synthetic
6	Past audit findings	synthetic
7	Source of truth per fact	synthetic
8	Programs	synthetic
9	Documents in the record	synthetic
10	Team, compliance lead, routing changes	synthetic
11	Team, compliance lead, routing changes	synthetic
12	Team, compliance lead, routing changes	synthetic
13	What "email" meant	synthetic
14	Email system and BAA	synthetic
15	Fix times and escalation	synthetic
16	Run cadence and record scope	synthetic
17	Reports	synthetic
18	Noteable admin, plan, capabilities	synthetic
19	Noteable admin, plan, capabilities	synthetic
20	AI tools and BAA	synthetic
21	Who signs agreements	synthetic
22	Anything else	synthetic
23	Noteable plan; who bills; billing cycle	synthetic
24	"Requires Approval" on billable templates; who approves	synthetic
25	Required fields on the note template	synthetic
26	MCO mix; units per authorization and review timing per MCO	synthetic
27	MCO mix; units per authorization and review timing per MCO	synthetic
28	Internal note deadline (day and evening groups)	synthetic
29	Services never billed and their codes	synthetic
30	Late-entry policy	synthetic
31	One-time lookback	synthetic
32	Proof-of-service letters	synthetic
33	Weekly client brief	synthetic
34	Denials: appeal, step down, who calls	synthetic
35	Noteable certification and written export capabilities	synthetic
36	Portal and clearinghouse export operators	synthetic

Payer profiles

DMAS fee-for-service

Field	Value / anchor	Evidence
initialFiling	12 months serviceDate	A-034 sources/virginia/ARTS_Ch5_Billing_rev2025-12-05.pdf
cobFiling	Unknown Unknown	Unknown Unknown
correctedClaim	Unknown Unknown	Unknown Unknown
reconsideration	Unknown Unknown	Unknown Unknown
reconsiderationDecision	Unknown Unknown	Unknown Unknown
secondReconsideration	Unknown Unknown	Unknown Unknown
paymentAppeal	30 calendar-days decisionReceipt	A-028 sources/virginia/DMAS_Provider_Appeal_Information_2021-05-21.pdf
disputeOverallLimit	Unknown Unknown	Unknown Unknown
authorizationUrgent	72 hours requestSubmittedAt	A-010 sources/virginia/ARTS_Ch4_CoveredServices_rev2025-07-07.pdf
authorizationStandard	Unknown Unknown	Unknown Unknown
initialRequest	1 business-days serviceStart	A-011 sources/virginia/ARTS_Ch4_CoveredServices_rev2025-07-07.pdf
continuedStay	0 calendar-days authorizationEnd	A-011 sources/virginia/ARTS_Ch4_CoveredServices_rev2025-07-07.pdf
cleanClaim99	Unknown Unknown	Unknown Unknown
cleanClaim100	Unknown Unknown	Unknown Unknown
recoveryNotice	Unknown Unknown	Unknown Unknown
recoveryLookback	Unknown Unknown	Unknown Unknown
peerDecision	Unknown Unknown	Unknown Unknown
peerRegistration	before-start condition serviceStart	A-063 sources/virginia/PeerServices_2023-12-29.pdf

Aetna Better Health of Virginia

Field	Value / anchor	Evidence
initialFiling	365 calendar-days serviceDateOrInpatientDischarge	M-007 sources/mco/Aetna_VA_2026-08.read.txt
cobFiling	365 calendar-days primaryRemittanceDate	M-007 sources/mco/Aetna_VA_2026-08.read.txt
correctedClaim	365 calendar-days lastPaidOrDeniedDate	M-007 sources/mco/Aetna_VA_2026-08.read.txt
reconsideration	365 calendar-days adjudicationDate	M-007 sources/mco/Aetna_VA_2026-08.read.txt
reconsiderationDecision	Unknown Unknown	Unknown Unknown
secondReconsideration	Unknown Unknown	Unknown Unknown
paymentAppeal	60 calendar-days denialDate	M-007 sources/mco/Aetna_VA_2026-08.read.txt
disputeOverallLimit	Unknown Unknown	Unknown Unknown
authorizationUrgent	72 hours requestReceivedAt	M-007 sources/mco/Aetna_VA_2026-08.read.txt
authorizationStandard	14 calendar-days requestReceivedAt	M-007 sources/mco/Aetna_VA_2026-08.read.txt
initialRequest	Unknown Unknown	Unknown Unknown
continuedStay	Unknown Unknown	Unknown Unknown
cleanClaim99	14 calendar-days cleanClaimReceiptOrMedicareAdjudication	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
cleanClaim100	30 calendar-days cleanClaimReceipt	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
recoveryNotice	Unknown Unknown	Unknown Unknown
recoveryLookback	Unknown Unknown	Unknown Unknown
peerDecision	14 calendar-days requestReceivedAt	M-007 sources/mco/Aetna_VA_2026-08.read.txt
peerRegistration	Unknown Unknown	Unknown Unknown

Anthem HealthKeepers Plus

Field	Value / anchor	Evidence
initialFiling	12 months serviceDateOrInpatientDischarge	M-008 sources/mco/Anthem_HKP_VA_Medicaid_ProviderManual_eff2026-07-01.pdf
cobFiling	12 months mostRecentOtherInsuranceEobDate	M-008 sources/mco/Anthem_HKP_VA_Medicaid_ProviderManual_eff2026-07-01.pdf
correctedClaim	within-clean-claim-period condition originalFilingDeadline	M-008 sources/mco/Anthem_HKP_VA_Medicaid_ProviderManual_eff2026-07-01.pdf
reconsideration	365 calendar-days eopDate	M-008 sources/mco/Anthem_HKP_VA_Medicaid_ProviderManual_eff2026-07-01.pdf
reconsiderationDecision	Unknown Unknown	Unknown Unknown
secondReconsideration	Unknown Unknown	Unknown Unknown
paymentAppeal	Unknown Unknown Alternative anchors are preserved; choice requires confirmation.	M-008 sources/mco/Anthem_HKP_VA_Medicaid_ProviderManual_eff2026-07-01.pdf
disputeOverallLimit	Unknown Unknown	Unknown Unknown
authorizationUrgent	Unknown Unknown	Unknown Unknown
authorizationStandard	Unknown Unknown	Unknown Unknown
initialRequest	Unknown Unknown	Unknown Unknown
continuedStay	Unknown Unknown	Unknown Unknown
cleanClaim99	14 calendar-days cleanClaimReceiptOrMedicareAdjudication	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
cleanClaim100	30 calendar-days cleanClaimReceipt	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
recoveryNotice	Unknown Unknown	Unknown Unknown
recoveryLookback	Unknown Unknown	Unknown Unknown
peerDecision	Unknown Unknown	Unknown Unknown
peerRegistration	Unknown Unknown	Unknown Unknown

Humana Healthy Horizons in Virginia

Field	Value / anchor	Evidence
initialFiling	365 calendar-days serviceDate	M-009 sources/mco/Humana_HH_VA_ProviderResourceGuide.pdf
cobFiling	Unknown Unknown	Unknown Unknown
correctedClaim	180 calendar-days eopReceiptDate	M-009 sources/mco/Humana_HH_VA_ProviderResourceGuide.pdf
reconsideration	Unknown calendar-days Unknown Guide and claims website disagree on anchor.	M-009 sources/mco/Humana_HH_VA_ProviderResourceGuide.pdf
reconsiderationDecision	Unknown Unknown	Unknown Unknown
secondReconsideration	Unknown Unknown	Unknown Unknown
paymentAppeal	Unknown Unknown	Unknown Unknown
disputeOverallLimit	Unknown Unknown	Unknown Unknown
authorizationUrgent	Unknown Unknown	Unknown Unknown
authorizationStandard	Unknown Unknown	Unknown Unknown
initialRequest	Unknown Unknown	Unknown Unknown
continuedStay	Unknown Unknown	Unknown Unknown
cleanClaim99	14 calendar-days cleanClaimReceiptOrMedicareAdjudication	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
cleanClaim100	30 calendar-days cleanClaimReceipt	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
recoveryNotice	Unknown Unknown	Unknown Unknown
recoveryLookback	Unknown Unknown	Unknown Unknown
peerDecision	Unknown Unknown	Unknown Unknown
peerRegistration	Unknown Unknown	Unknown Unknown

Sentara Community Plan

Field	Value / anchor	Evidence
initialFiling	365 calendar-days serviceDate	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
cobFiling	18 months serviceDate	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
correctedClaim	365 calendar-days serviceDate	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
reconsideration	365 calendar-days lastServiceDate	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
reconsiderationDecision	Unknown Unknown	Unknown Unknown
secondReconsideration	60 calendar-days firstDeterminationLetterDate	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
paymentAppeal	Unknown Unknown	Unknown Unknown
disputeOverallLimit	Unknown Unknown	Unknown Unknown
authorizationUrgent	72 hours requestReceivedAt	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
authorizationStandard	Unknown Unknown	Unknown Unknown
initialRequest	before-start condition serviceStart	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
continuedStay	Unknown Unknown	Unknown Unknown
cleanClaim99	14 calendar-days cleanClaimReceiptOrMedicareAdjudication	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
cleanClaim100	30 calendar-days cleanClaimReceipt	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
recoveryNotice	Unknown Unknown	Unknown Unknown
recoveryLookback	3 years paymentDate	M-010 sources/mco/Sentara_VA_Medicaid_ProviderManual_2026-10-01.pdf
peerDecision	Unknown Unknown	Unknown Unknown
peerRegistration	Unknown Unknown	Unknown Unknown

UnitedHealthcare Community Plan

Field	Value / anchor	Evidence
initialFiling	365 calendar-days serviceDateOrInpatientDischarge	M-011 sources/mco/UHC_CommunityPlan_VA_ProviderManual_2026.pdf
cobFiling	Unknown Unknown	Unknown Unknown
correctedClaim	Unknown calendar-days Unknown Manual rejected-claim wording uses 90 days from service or close of business from primary carrier; confirm applicable anchor.	M-011 sources/mco/UHC_CommunityPlan_VA_ProviderManual_2026.pdf
reconsideration	later-of compound Unknown	M-011 sources/mco/UHC_CommunityPlan_VA_ProviderManual_2026.pdf
reconsiderationDecision	45 business-days reconsiderationReceipt	M-011 sources/mco/UHC_CommunityPlan_VA_ProviderManual_2026.pdf
secondReconsideration	Unknown Unknown	Unknown Unknown
paymentAppeal	30 calendar-days lastAdverseDeterminationDate	M-011 sources/mco/UHC_CommunityPlan_VA_ProviderManual_2026.pdf
disputeOverallLimit	1 years firstEopDate	M-011 sources/mco/UHC_CommunityPlan_VA_ProviderManual_2026.pdf
authorizationUrgent	Unknown Unknown	Unknown Unknown
authorizationStandard	Unknown calendar-days Unknown General standard 7 days and behavioral nonurgent 14 days; select only after service-specific validation.	M-011 sources/mco/UHC_CommunityPlan_VA_ProviderManual_2026.pdf
initialRequest	Unknown Unknown	Unknown Unknown
continuedStay	Unknown Unknown	Unknown Unknown
cleanClaim99	14 calendar-days cleanClaimReceiptOrMedicareAdjudication	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
cleanClaim100	30 calendar-days cleanClaimReceipt	M-005 sources/mco/DMAS_CardinalCare_MCO_Contract_FY2027_2026-07-01.pdf
recoveryNotice	Unknown Unknown	Unknown Unknown
recoveryLookback	Unknown Unknown	Unknown Unknown
peerDecision	Unknown Unknown	Unknown Unknown
peerRegistration	Unknown Unknown	Unknown Unknown