Sam Rivera (C-0021)
2.5 · DMAS · 2026-09-26 admission
Episode clocks
| Clock | Due | Result / evidence |
|---|---|---|
| TIME-ISP-INITIAL Initial treatment plan (initial ISP) | 2026-09-27 | fail DMAS Clock overdue; Within 24 hours of admission, covering immediate service, health and safety needs. |
| TIME-AUTH-REQUEST Initial approval request sent to the plan | 2026-09-28 | fail DMAS Verified payer profile |
| TIME-AUTH-DECISION Plan's decision due | 2026-09-29 | pass DMAS Verified payer profile; exact due 2026-09-29T13:00:00.000Z |
| TIME-ISP-COMPREHENSIVE Comprehensive treatment plan (comprehensive ISP) | 2026-10-26 | pass DMAS Clock met; Within 30 calendar days of starting services, required even if the person is discharged earlier. |
| TIME-ASSESS-FRESH Services must start within 30 days of the assessment | 2026-10-26 | pass DMAS Clock met; If services start later than 30 days after the assessment is completed, the assessment has to be redone. |
| TIME-ISP-REVIEW Next treatment plan review | 2026-10-26 | pass DMAS Clock upcoming; At least every 30 calendar days at ASAM 2.5, and whenever needs change. A plan not updated on time is "outdated". |
| TIME-EXT-REQUEST Extension (continued-stay) request | 2026-11-01 | pass DMAS Verified payer profile |
| TIME-DMAS-PROVIDER-APPEAL-30 Provider's informal appeal at DMAS | Exact anchor unavailable | skipped DMAS Primary applicable source unavailable: A-029 |
| TIME-NO-CONTACT-31 No contact for 31 days: discharge decision | 2026-11-07 | pass DMAS Clock upcoming; A lapse of more than 31 consecutive days with no communication means the program shall discharge the person. This date is the day to decide, one day early on purpose. |
| TIME-MEMBER-APPEAL-60 Member's appeal to the health plan (provider files only with the member's written consent) | 2026-11-30 | pass DMAS Clock upcoming; 60 calendar days from the date on the notice. A provider needs the member’s written consent and cannot request continued benefits. |
Findings 5
| Finding / record | Priority · payer | Owner · due | Evidence / state |
|---|---|---|---|
| WEEK-HOURS Sam Rivera (C-0021) · E-21:2026-09-27 WEEK-HOURS | watch DMAS | clinical-director · Harper Brooks (S-05) 2026-10-15 | open A-016 Condition requires review Review action |
| TIME-ISP-INITIAL Sam Rivera (C-0021) · E-21:ISP-INITIAL Initial treatment plan (initial ISP) | important DMAS | ur · Cameron Lee (S-11) 2026-09-27 | open A-022, L-010 Clock overdue; Within 24 hours of admission, covering immediate service, health and safety needs. Review action |
| TIME-AUTH-REQUEST Sam Rivera (C-0021) · E-21:AUTH-REQUEST Initial approval request sent to the plan | urgent DMAS | ur · Cameron Lee (S-11) 2026-09-28 | open A-011 Verified payer profile Review action |
| CLAR-PLAN-VS-DELIVERY Sam Rivera (C-0021) · PS-21 Delivery compared with complete planned period | important DMAS | clinical-director · Harper Brooks (S-05) 2026-10-14 | open A-026 Condition requires review Review action |
| REV-APPROVED-NO-CLAIM Sam Rivera (C-0021) · N-DEMO-APPROVED approved no claim | important DMAS | billing · Drew Santos (S-12) 2026-10-05 | open Versioned house policy Condition requires review Review action |
Units ledger
| Authorization · payer | Units authorized | Delivered / approved / billed | Remaining · end |
|---|---|---|---|
| AU-DEMO-21 · DMAS S0201 · day | 30 | 4 / 4 / 3 | 26 · 2026-11-02 |
Mindful Note Review
| Note | Readiness | Review state |
|---|---|---|
| N-SHOW-21-0 2026-10-02 | ready | reconciled |
| N-SHOW-21-1 2026-10-03 | ready | reconciled |
| N-SHOW-21-2 2026-10-04 | ready | reconciled |
| N-DEMO-APPROVED 2026-09-30 | ready | approved |
Mailbox and team
| Line | Status |
|---|---|
| CH-044 · Confirmation of receipt for Sam Rivera (C-0021). | Cataloged receipt |
| CH-045 · Clarification requires follow-up for Sam Rivera (C-0021). | Open clarification / follow-up |
| CH-046 · Team update recorded; not posted for Sam Rivera (C-0021). | Not posted |
| CH-049 · Follow-up required for Sam Rivera (C-0021). | Not sent |
Documents in this record
Supplied demo artifacts. Open a document to inspect its type, version and structured evidence.
| Document · date | Author · status | Evidence |
|---|---|---|
| demographics SHOW-21-FACE 2026-09-26 | Jamie Ross (S-08) signed · version 1 | View supplied demo artifactDEMO RECORD SHOW-21 FACE No structured element list Created 2026-09-26T16:00:00-04:00 |
| plan SHOW-21-PLAN 2026-09-26 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO RECORD SHOW-21 PLAN needs, goals, services, agencies, discharge, family, aftercare, pharmacotherapy, choice, signature, levelOfCare Created 2026-09-26T16:00:00-04:00 |
| assessment SHOW-21-ASSESS 2026-09-26 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO RECORD SHOW-21 ASSESS history, medical, psychiatric, substance, risk, strengths, riskRating, immediateNeeds Created 2026-09-26T16:00:00-04:00 |
| medication-list SHOW-21-MEDS 2026-09-26 | Dr. Quinn Mercer (S-09) signed · version 1 | View supplied demo artifactDEMO RECORD SHOW-21 MEDS No structured element list Created 2026-09-26T16:00:00-04:00 |
| consent SHOW-21-CONSENT 2026-09-26 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO RECORD SHOW-21 CONSENT signature, signedDate Created 2026-09-26T16:00:00-04:00 |
| authorization SHOW-21-AUTH 2026-09-26 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO RECORD SHOW-21 AUTH No structured element list Created 2026-09-26T16:00:00-04:00 |
| note D-N-SHOW-21-0 2026-10-02 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO NOTE 21 0 setting, intervention, response, goal, humanSemanticReviewed Created 2026-10-02T16:00:00-04:00 |
| note D-N-SHOW-21-1 2026-10-03 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO NOTE 21 1 setting, intervention, response, goal, humanSemanticReviewed Created 2026-10-03T16:00:00-04:00 |
| note D-N-SHOW-21-2 2026-10-04 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO NOTE 21 2 setting, intervention, response, goal, humanSemanticReviewed Created 2026-10-04T16:00:00-04:00 |
| note D-N-DEMO-APPROVED 2026-09-30 | Dana Patel (S-01) signed · version 1 | View supplied demo artifactDEMO QUEUE N-DEMO-APPROVED setting, intervention, response, goal, humanSemanticReviewed Created 2026-09-30T16:00:00-04:00 |
Diagnoses, medication and planned services
Fictional chart facts. Medication codes and doses are demonstration placeholders.
Diagnoses
| Code | Document | Recorded by |
|---|---|---|
| F10.20 | SHOW-21-ASSESS | Dr. Quinn Mercer (S-09) |
| F10.20 | SHOW-21-PLAN | Dr. Quinn Mercer (S-09) |
Medication reconciliation
| Medication | Dose · route · schedule | Record |
|---|---|---|
| DEMO-MED-A | DEMO-DOSE-A · demo-route demo-schedule | SHOW-21-MEDS · active |
| DEMO-MED-A | DEMO-DOSE-A · demo-route demo-schedule | SHOW-21-PLAN · active |
Planned services
| Service | Frequency · target | Source |
|---|---|---|
| S0201 | 3 sessions weekly 2026-10-26 | SHOW-21-PLAN |
Consent and coverage
| Record | Scope | Status |
|---|---|---|
| CON-SHOW-21 | part2 · demo-payment DMAS | 2026-09-26 through 2027-10-08 9 structured elements |
| CV-Sam Rivera (C-0021) | DMAS | 2026-01-01 through open ended Verified demo coverage |
Claims and remittances
| Claim · service | Units · payer | Status · related note |
|---|---|---|
| CLM-SHOW-21-0 2026-10-02 · S0201 | 1 day DMAS | denied N-SHOW-21-0 |
| CLM-SHOW-21-1 2026-10-03 · S0201 | 1 day DMAS | submitted N-SHOW-21-1 |
| CLM-SHOW-21-2 2026-10-04 · S0201 | 1 day DMAS | submitted N-SHOW-21-2 |
Remittances and denial follow-up
| Claim | Decision · date | Follow-up |
|---|---|---|
| CLM-SHOW-21-0 | denied · 2026-10-04 DEMO-REVIEW | 2026-10-05 |
| CLM-SHOW-21-1 | partial · 2026-10-05 DEMO-REVIEW | No work action recorded |
| CLM-SHOW-21-2 | partial · 2026-10-06 DEMO-REVIEW | No work action recorded |
Executed checks and source gaps
113 passed · 5 failed · 29 skipped
| Rule / subject | Result | Evidence |
|---|---|---|
| NOTE-LATE N-SHOW-21-0 | pass | Required inputs checked |
| NOTE-UNSIGNED N-SHOW-21-0 | pass | Required inputs checked |
| NOTE-NO-TIME N-SHOW-21-0 | pass | Required inputs checked |
| NOTE-CLONED N-SHOW-21-0 | pass | Required inputs checked |
| NOTE-COSIGN N-SHOW-21-0 | pass | Required inputs checked |
| NOTE-TIMES N-SHOW-21-0 | skipped | MH time rule not applicable |
| GROUP-SIZE N-SHOW-21-0 | skipped | Group size not supplied or not a group note |
| NOTE-LATE N-SHOW-21-1 | pass | Required inputs checked |
| NOTE-UNSIGNED N-SHOW-21-1 | pass | Required inputs checked |
| NOTE-NO-TIME N-SHOW-21-1 | pass | Required inputs checked |
| NOTE-CLONED N-SHOW-21-1 | pass | Required inputs checked |
| NOTE-COSIGN N-SHOW-21-1 | pass | Required inputs checked |
| NOTE-TIMES N-SHOW-21-1 | skipped | MH time rule not applicable |
| GROUP-SIZE N-SHOW-21-1 | skipped | Group size not supplied or not a group note |
| NOTE-LATE N-SHOW-21-2 | pass | Required inputs checked |
| NOTE-UNSIGNED N-SHOW-21-2 | pass | Required inputs checked |
| NOTE-NO-TIME N-SHOW-21-2 | pass | Required inputs checked |
| NOTE-CLONED N-SHOW-21-2 | pass | Required inputs checked |
| NOTE-COSIGN N-SHOW-21-2 | pass | Required inputs checked |
| NOTE-TIMES N-SHOW-21-2 | skipped | MH time rule not applicable |
| GROUP-SIZE N-SHOW-21-2 | skipped | Group size not supplied or not a group note |
| NOTE-LATE N-DEMO-APPROVED | pass | Required inputs checked |
| NOTE-UNSIGNED N-DEMO-APPROVED | pass | Required inputs checked |
| NOTE-NO-TIME N-DEMO-APPROVED | pass | Required inputs checked |
| NOTE-CLONED N-DEMO-APPROVED | pass | Required inputs checked |
| NOTE-COSIGN N-DEMO-APPROVED | pass | Required inputs checked |
| NOTE-TIMES N-DEMO-APPROVED | skipped | MH time rule not applicable |
| GROUP-SIZE N-DEMO-APPROVED | skipped | Group size not supplied or not a group note |
| WEEK-HOURS E-21:2026-09-27 | fail | Condition requires review |
| DAY-HOURS E-21:2026-10-02 | pass | Required inputs checked |
| DAY-HOURS E-21:2026-10-03 | pass | Required inputs checked |
| DAY-HOURS E-21:2026-10-04 | pass | Required inputs checked |
| SERVICE-NO-AUTH E-21:gap | pass | Required inputs checked |
| SERVICE-NO-AUTH E-21:pending | pass | Required inputs checked |
| PLAN-ELEMENTS P-SHOW-21 | pass | Required inputs checked |
| ASSESS-DIMENSIONS AS-SHOW-21 | pass | Required inputs checked |
| ASSESS-MISSING E-21 | pass | Required inputs checked |
| TIME-ISP-INITIAL E-21:ISP-INITIAL | fail | Clock overdue; Within 24 hours of admission, covering immediate service, health and safety needs. |
| TIME-AUTH-REQUEST E-21:AUTH-REQUEST | fail | Verified payer profile |
| TIME-AUTH-DECISION E-21:AUTH-DECISION | pass | Verified payer profile; exact due 2026-09-29T13:00:00.000Z |
| TIME-ISP-COMPREHENSIVE E-21:ISP-COMPREHENSIVE | pass | Clock met; Within 30 calendar days of starting services, required even if the person is discharged earlier. |
| TIME-ASSESS-FRESH E-21:ASSESS-FRESH | pass | Clock met; If services start later than 30 days after the assessment is completed, the assessment has to be redone. |
| TIME-ISP-REVIEW E-21:ISP-REVIEW | pass | Clock upcoming; At least every 30 calendar days at ASAM 2.5, and whenever needs change. A plan not updated on time is "outdated". |
| TIME-EXT-REQUEST E-21:EXT-REQUEST:AU-DEMO-21 | pass | Verified payer profile |
| TIME-DMAS-PROVIDER-APPEAL-30 E-21:DMAS-PROVIDER-APPEAL-30:D-SHOW-21 | skipped | Primary applicable source unavailable: A-029 |
| TIME-NO-CONTACT-31 E-21:NO-CONTACT-31 | pass | Clock upcoming; A lapse of more than 31 consecutive days with no communication means the program shall discharge the person. This date is the day to decide, one day early on purpose. |
| TIME-MEMBER-APPEAL-60 E-21:MEMBER-APPEAL-60:D-SHOW-21 | pass | Clock upcoming; 60 calendar days from the date on the notice. A provider needs the member’s written consent and cannot request continued benefits. |
| CONS-DEMO-NAME E-21 | skipped | Two comparable identity sources are required |
| CONS-DEMO-DOB E-21 | skipped | Two comparable identity sources are required |
| CONS-DEMO-ADDRESS E-21 | skipped | Two comparable identity sources are required |
| CONS-DEMO-PHONE E-21 | skipped | Two comparable identity sources are required |
| CONS-DEMO-SSN E-21 | skipped | Two comparable identity sources are required |
| CONS-DEMO-GENDER E-21 | skipped | Two comparable identity sources are required |
| CONS-DEMO-MEDICAID E-21 | skipped | Two comparable identity sources are required |
| CONS-DX E-21 | pass | Required inputs checked |
| CONS-MEDS E-21 | pass | Required inputs checked |
| CONS-LOC E-21 | pass | Required inputs checked |
| CONS-PAYER E-21 | pass | Required inputs checked |
| CONS-DATES E-21 | pass | Required inputs checked |
| COMP-SIGNED SHOW-21-FACE | pass | Required inputs checked |
| COMP-ISP-CLIENT-SIG SHOW-21-PLAN | pass | Required inputs checked |
| COMP-INFORMED-CHOICE SHOW-21-PLAN | pass | Required inputs checked |
| COMP-DISCHARGE-PLAN SHOW-21-PLAN | pass | Required inputs checked |
| COMP-SIGNED SHOW-21-PLAN | pass | Required inputs checked |
| COMP-ASSESS-PROFILE SHOW-21-ASSESS | pass | Required inputs checked |
| COMP-ASSESS-ELEMENTS SHOW-21-ASSESS | pass | Required inputs checked |
| COMP-SIGNED SHOW-21-ASSESS | pass | Required inputs checked |
| COMP-SIGNED SHOW-21-MEDS | pass | Required inputs checked |
| COMP-SIGNED SHOW-21-CONSENT | pass | Required inputs checked |
| COMP-SIGNED SHOW-21-AUTH | pass | Required inputs checked |
| COMP-NOTE-FIELDS D-N-SHOW-21-0 | pass | Required inputs checked |
| COMP-SIGNED D-N-SHOW-21-0 | pass | Required inputs checked |
| COMP-NOTE-FIELDS D-N-SHOW-21-1 | pass | Required inputs checked |
| COMP-SIGNED D-N-SHOW-21-1 | pass | Required inputs checked |
| COMP-NOTE-FIELDS D-N-SHOW-21-2 | pass | Required inputs checked |
| COMP-SIGNED D-N-SHOW-21-2 | pass | Required inputs checked |
| COMP-NOTE-FIELDS D-N-DEMO-APPROVED | pass | Required inputs checked |
| COMP-SIGNED D-N-DEMO-APPROVED | pass | Required inputs checked |
| COMP-MOUD E-21 | pass | Required inputs checked |
| PEOPLE-CRED-SCOPE SHOW-21-PLAN | pass | Required inputs checked |
| PEOPLE-CRED-SCOPE SHOW-21-ASSESS | pass | Required inputs checked |
| ASAM-DX-BY-LICENSED DX-A-21 | pass | Required inputs checked |
| ASAM-DX-BY-LICENSED DX-P-21 | pass | Required inputs checked |
| CLAR-ISP-FREQ-MISSING PS-21 | pass | Required inputs checked |
| CLAR-ISP-FREQ-AMBIG PS-21 | pass | Required inputs checked |
| CLAR-PLAN-VS-DELIVERY PS-21 | fail | Condition requires review |
| CLAR-GOALS-MEASURABLE E-21 | skipped | No qualified text-reader assessment supplied; not a pass |
| CLAR-NOTE-GOAL-LINK E-21 | skipped | No qualified text-reader assessment supplied; not a pass |
| CLAR-NOTE-TIME-SUPPORT E-21 | skipped | No qualified text-reader assessment supplied; not a pass |
| CLAR-CONTRADICTION E-21 | skipped | No qualified text-reader assessment supplied; not a pass |
| ASAM-CONTINUED-STAY E-21 | skipped | No qualified text-reader assessment supplied; not a pass |
| COMP-PART2-CONSENT CON-SHOW-21 | pass | Required inputs checked |
| COMP-PART2-DISCLOSURE CON-SHOW-21 | pass | Required inputs checked |
| COMP-CRIMINAL-JUSTICE-CONSENT CON-SHOW-21 | skipped | Not a criminal justice referral |
| REV-ATTEND-NO-NOTE SES-SHOW-21-0 | pass | Note exists |
| REV-ATTEND-NO-NOTE SES-SHOW-21-1 | pass | Note exists |
| REV-ATTEND-NO-NOTE SES-SHOW-21-2 | pass | Note exists |
| REV-ATTEND-NO-NOTE SES-N-DEMO-APPROVED | pass | Note exists |
| REV-NOTE-RETURNED-OPEN N-SHOW-21-0 | pass | Required inputs checked |
| REV-APPROVAL-LAG N-SHOW-21-0 | pass | Required inputs checked |
| REV-LATE-ENTRY-HOLD N-SHOW-21-0 | pass | Required inputs checked |
| REV-APPROVED-NO-CLAIM N-SHOW-21-0 | pass | Required inputs checked |
| REV-TIMELY-FILING N-SHOW-21-0 | pass | Verified payer profile |
| REV-SERVICE-UNBILLED N-SHOW-21-0 | skipped | No separately billable configured service |
| FLOW-UNREVIEWED N-SHOW-21-0 | pass | Required inputs checked |
| FLOW-MISMATCH N-SHOW-21-0 | pass | Required inputs checked |
| REV-NOTE-RETURNED-OPEN N-SHOW-21-1 | pass | Required inputs checked |
| REV-APPROVAL-LAG N-SHOW-21-1 | pass | Required inputs checked |
| REV-LATE-ENTRY-HOLD N-SHOW-21-1 | pass | Required inputs checked |
| REV-APPROVED-NO-CLAIM N-SHOW-21-1 | pass | Required inputs checked |
| REV-TIMELY-FILING N-SHOW-21-1 | pass | Verified payer profile |
| REV-SERVICE-UNBILLED N-SHOW-21-1 | skipped | No separately billable configured service |
| FLOW-UNREVIEWED N-SHOW-21-1 | pass | Required inputs checked |
| FLOW-MISMATCH N-SHOW-21-1 | pass | Required inputs checked |
| REV-NOTE-RETURNED-OPEN N-SHOW-21-2 | pass | Required inputs checked |
| REV-APPROVAL-LAG N-SHOW-21-2 | pass | Required inputs checked |
| REV-LATE-ENTRY-HOLD N-SHOW-21-2 | pass | Required inputs checked |
| REV-APPROVED-NO-CLAIM N-SHOW-21-2 | pass | Required inputs checked |
| REV-TIMELY-FILING N-SHOW-21-2 | pass | Verified payer profile |
| REV-SERVICE-UNBILLED N-SHOW-21-2 | skipped | No separately billable configured service |
| FLOW-UNREVIEWED N-SHOW-21-2 | pass | Required inputs checked |
| FLOW-MISMATCH N-SHOW-21-2 | pass | Required inputs checked |
| REV-NOTE-RETURNED-OPEN N-DEMO-APPROVED | pass | Required inputs checked |
| REV-APPROVAL-LAG N-DEMO-APPROVED | pass | Required inputs checked |
| REV-LATE-ENTRY-HOLD N-DEMO-APPROVED | pass | Required inputs checked |
| REV-APPROVED-NO-CLAIM N-DEMO-APPROVED | fail | Condition requires review |
| REV-TIMELY-FILING N-DEMO-APPROVED | pass | Verified payer profile |
| REV-SERVICE-UNBILLED N-DEMO-APPROVED | skipped | No separately billable configured service |
| FLOW-UNREVIEWED N-DEMO-APPROVED | pass | Required inputs checked |
| FLOW-MISMATCH N-DEMO-APPROVED | pass | Required inputs checked |
| REV-CLAIM-NO-NOTE CL-CLM-SHOW-21-0 | pass | Required inputs checked |
| REV-PAYER-CREDENTIAL CL-CLM-SHOW-21-0 | pass | Required inputs checked |
| REV-COVERAGE-CHANGE CL-CLM-SHOW-21-0 | pass | Required inputs checked |
| REV-CLAIM-NO-NOTE CL-CLM-SHOW-21-1 | pass | Required inputs checked |
| REV-PAYER-CREDENTIAL CL-CLM-SHOW-21-1 | pass | Required inputs checked |
| REV-COVERAGE-CHANGE CL-CLM-SHOW-21-1 | pass | Required inputs checked |
| REV-CLAIM-NO-NOTE CL-CLM-SHOW-21-2 | pass | Required inputs checked |
| REV-PAYER-CREDENTIAL CL-CLM-SHOW-21-2 | pass | Required inputs checked |
| REV-COVERAGE-CHANGE CL-CLM-SHOW-21-2 | pass | Required inputs checked |
| REV-UNITS-OVER-AUTH AU-DEMO-21 | pass | Required inputs checked |
| REV-UNITS-BURN AU-DEMO-21 | pass | Required inputs checked |
| PAYER-DENIAL-DEADLINE RM-CLM-SHOW-21-0 | skipped | No verified payer field or applicable DMAS fallback |
| REV-DENIAL-UNWORKED RM-CLM-SHOW-21-0 | pass | House follow-up deadline; payer appeal clock is separately sourced |
| PAYER-DENIAL-DEADLINE RM-CLM-SHOW-21-1 | skipped | No denial |
| REV-DENIAL-UNWORKED RM-CLM-SHOW-21-1 | pass | House follow-up deadline; payer appeal clock is separately sourced |
| PAYER-DENIAL-DEADLINE RM-CLM-SHOW-21-2 | skipped | No denial |
| REV-DENIAL-UNWORKED RM-CLM-SHOW-21-2 | pass | House follow-up deadline; payer appeal clock is separately sourced |