Thursday, October 30
18 requests are moving.
14 are on track. 3 need you.
→→→
Handled in the background since Friday: 11 reminders sent · 3 replies matched · 2 invoices checked · 212 pages read · so your team didn’t have to.
Today · needs you 3
You’re all caught up.
14 requests are on track. We’ll surface anything that needs you the moment it does.
4 intakes are read and waiting to confirm
From your claim system, intake inbox and uploads
Invoices · to approve 3
At a glance
Claim
CLM-00048213 · Jordan Sample
General
Claim number
CLM-00048213
Client matter number
—
Line of business
Auto
Date of loss
07/22/2026
Primary
Ellen Park (you)
Backup
Sofia Rivera
Records needed
07/22/2026 – present
Scope
All medical records excluding mental health
Claimant
Claimant name
Jordan Sample
Role
Claimant
Date of birth
01/15/1985
Gender
Female
Address
Columbus, OH (sample)
Authorizations on file
General authorization
Signed 07/30/2026 · expires 07/30/2027
Lakeside Orthopedic authorization
Facility-specific form · signed 07/30/2026
Records spend on this claim: $0.00
Requests 4
| Request | Facility | State | Validation | Next step |
|---|---|---|---|---|
| Records in | ✓ Passed | Partial: follow-up prepared | ||
| Invalid | ✕ facility found no patient under this DOB | Correct the DOB and resend · Issue #12 | ||
| Sent | ✓ Passed | Reminder Oct 09 | ||
| Blocked | ✕ no facility fax or email | Add contact details · Issue #13 |
Each request is validated before it’s sent and again when records arrive. Anything that fails opens an issue. Open a request for its full activity log.
Invoices 1
Records spend: $0.00| Facility | Amount | Status | Received | |
|---|---|---|---|---|
| Northfield Regional Hospital | $42.50 | Needs approval | email · Oct 05 |
Records & claim packet
Northfield Regional · records, 212 pages
Oct 06 · in review
Claim packet
All accepted records, logs and summaries go to the claim system together when the claim’s requests are complete.
Activity
Every action on this claim, its requests, invoices and recordsDuplicate request held: Northfield already has an open request for these dates (#17).
Seabreeze Family Practice has no fax or email; request blocked (#13).
Northfield Regional records received, 212 pages. Sent to Records to Review.
Northfield invoice $42.50 received; over your $25 limit, routed for approval.
Lakeside replied “no patient found” under this DOB; request marked Invalid (#12).
Sent 4 requests for Jordan Sample (Northfield, Lakeside, Brightline, Seabreeze).
Created claim from uploaded intake; confirmed claimant and scope.
Open issues 3
#12 Invalid request data
Lakeside can’t match the patient
#13 Missing facility contact
Seabreeze Family Practice
#11 Partial records
Northfield records stop at 08/30
This is the claim-level view of the same activity trail kept on each request and in the Audit log.
Claim
CLM-00048190 · R. Example
General
Claim number
CLM-00048190
Client matter number
M-2026-0117
Line of business
Auto
Date of loss
08/14/2026
Primary
Ellen Park (you)
Backup
Sofia Rivera
Records needed
08/14/2021 – present
Scope
Records + itemized bill
Claimant
Claimant name
R. Example
Role
Claimant
Date of birth
06/30/1979
Gender
Male
Address
Grove City, OH (sample)
Authorizations on file
General authorization
Signed 08/20/2026 · expires 08/20/2027
Records spend on this claim: $30.50
Requests 4
| Request | Facility | State | Validation | Next step |
|---|---|---|---|---|
| Delivered | ✓ Passed | In claim packet | ||
| Records in | ✓ Passed | Ready to review | ||
| Stalled | ✓ Passed | No response in 14 days · Issue #14 | ||
| Verified | ✓ Passed | Accept to add to packet |
Each request is validated before it’s sent and again when records arrive. Anything that fails opens an issue. Open a request for its full activity log.
Invoices 2
Records spend: $30.50| Facility | Amount | Status | Received | |
|---|---|---|---|---|
| Lakeside Orthopedic Clinic | $18.00 | Paid | fax · Oct 04 | |
| Riverbend Urgent Care | $12.50 | Paid | portal · Oct 05 |
Records & claim packet
Northfield Regional · records, 84 pages
Delivered Oct 01
Riverbend Urgent Care · 6 pages
Oct 05 · verified
Claim packet
All accepted records, logs and summaries go to the claim system together when the claim’s requests are complete.
Activity
Every action on this claim, its requests, invoices and recordsNo response from Harbor Imaging in 14 days; request Stalled (#14).
Called Harbor Imaging; film library backed up, left voicemail.
Riverbend Urgent Care records received, 6 pages. Verified.
Northfield Regional records delivered to claim packet, 84 pages.
Sent 4 requests for R. Example.
Open issues 1
#14 Stalled request
Harbor Imaging, no response in 14 days
This is the claim-level view of the same activity trail kept on each request and in the Audit log.
Claim
CLM-00048177 · T. Demo
General
Claim number
CLM-00048177
Client matter number
—
Line of business
Home
Date of loss
09/01/2026
Primary
Sofia Rivera
Backup
Ellen Park (you)
Records needed
09/01/2026 – present
Scope
Imaging reports
Claimant
Claimant name
T. Demo
Role
Claimant
Date of birth
04/09/1971
Gender
Female
Address
Dublin, OH (sample)
Authorizations on file
General authorization
Signed 09/05/2026 · expires 09/05/2027
Records spend on this claim: $65.00
Requests 2
| Request | Facility | State | Validation | Next step |
|---|---|---|---|---|
| Records in | ✕ pages 36–38 belong to another patient | Report wrong-patient pages · Issue #15 | ||
| Ready | ✓ Passed | Sends tomorrow 8:00 AM |
Each request is validated before it’s sent and again when records arrive. Anything that fails opens an issue. Open a request for its full activity log.
Invoices 1
Records spend: $65.00| Facility | Amount | Status | Received | |
|---|---|---|---|---|
| Harbor Imaging Center | $65.00 | Needs approval | email · Oct 02 |
Records & claim packet
Harbor Imaging · reports, 38 pages
Oct 02 · 3 pages held back
Claim packet
All accepted records, logs and summaries go to the claim system together when the claim’s requests are complete.
Activity
Every action on this claim, its requests, invoices and recordsReviewed wrong-patient pages 36–38; held back, incident open (#15).
Harbor Imaging reports received, 38 pages; 3 pages flagged wrong-patient.
Sent request to Harbor Imaging.
Open issues 1
#15 Wrong-patient records
Harbor Imaging pages 36–38
This is the claim-level view of the same activity trail kept on each request and in the Audit log.
Claim
CLM-00048102 · K. Fixture
General
Claim number
CLM-00048102
Client matter number
—
Line of business
Auto
Date of loss
06/02/2026
Primary
Ellen Park (you)
Backup
—
Records needed
06/02/2026 – present
Scope
All medical records
Claimant
Claimant name
K. Fixture
Role
Claimant
Date of birth
02/11/1990
Gender
Male
Address
Columbus, OH (sample)
Authorizations on file
General authorization
Signed 06/05/2026 · expired use not needed
Records spend on this claim: $0.00
Requests 2
| Request | Facility | State | Validation | Next step |
|---|---|---|---|---|
| Closed | ✓ Passed | Delivered Sep 19 | ||
| Closed | ✓ Passed | Delivered Sep 26 |
Each request is validated before it’s sent and again when records arrive. Anything that fails opens an issue. Open a request for its full activity log.
Invoices 0
Records spend: $0.00No invoices on this claim yet.
Records & claim packet
Claim packet · 2 deliveries
Sent to claim system Sep 30
Claim packet
All accepted records, logs and summaries go to the claim system together when the claim’s requests are complete.
Activity
Every action on this claim, its requests, invoices and recordsClaim packet delivered to claim system; claim closed.
Brightline Logistics records delivered.
Northfield Regional records delivered.
Open issues 0
No open issues.
This is the claim-level view of the same activity trail kept on each request and in the Audit log.
Request · child of claim CLM-00048213
R-48213-02 · Lakeside Orthopedic Clinic
- Draft
- Validating
- Ready
- Sent
- Acknowledged
- Invoice & payment
- Records in
- Verified
- Delivered
- Closed
Facility can’t match the patient — date of birth mismatch
Lakeside has a Jordan Sample with DOB 01/16/1985, not 01/15/1985. Correct it below and resend.
Fix & resendRe-validates, reopens the request, and closes issue #12 on success.
Date of birthfacility says 01/16/1985
correct, then resend
Request details
Claim
CLM-00048213
Claimant
Jordan Sample
Records requested
Any and all medical & billing records · 07/22/2026 – present
Days open
11
Sent as
Authorization + Lakeside facility form
First sent
Oct 01
Channel
Fax
Fee
—
Validation
✕ Facility found no patient under DOB 01/15/1985
Activity 3
Called Pat Nguyen at Lakeside; confirmed receipt, checking the DOB on our intake.
Lakeside replied “no patient found” under the DOB provided. Marked Invalid; Issue #12 opened.
Faxed to Lakeside with the signed authorization and facility form (5 pages).
Facility
Facility
Records Request Activity Log
Prepared on behalf of GOLD Life Claims Department
Request R-48213-02
Generated 10/30/2026 9:14 AM ET
Generated 10/30/2026 9:14 AM ET
| Claim number | CLM-00048213 | Records custodian | Lakeside Orthopedic Clinic 455 Lakeside Dr, Suite 200, Columbus, OH 43220 |
|---|---|---|---|
| Claimant | Jordan Sample | Custodian contact | Phone (555) 010-3380 · Fax (555) 010-3381 |
| Records requested | Any and all medical & billing records · 07/22/2026 – present | Authority for request | HIPAA authorization signed 07/30/2026 (Exhibit A) |
| First requested | 10/01/2026 | Days outstanding | 11 days as of 10/30/2026 |
Summary of attempts
| 1 fax delivered | 0 emails — | 1 phone call identity check | 0 records received awaiting correction |
Chronological activity
| Date | Time (ET) | By | Method | Activity |
|---|---|---|---|---|
| 10/01/2026 | 9:15 AM | System | Fax | Request R-48213-02 faxed to Lakeside with signed authorization and facility form (5 pages). Delivered. |
| 10/04/2026 | 2:40 PM | System | Fax | Lakeside replied “no patient found” under the DOB provided. Marked Invalid; Issue #12 opened. |
| 10/07/2026 | 11:05 AM | Ellen Park (Adjuster) | Phone call | Called Pat Nguyen. Confirmed receipt; checking the DOB on our intake. |
Automated entries are recorded by the system when the action occurs. User entries are recorded under the named user’s login with the date and time of entry. Entries cannot be edited or deleted after they are saved.
Prepared by: ______________________________
Title: ____________________
Date: ______________
Exhibits: A. Authorization · B. Original request letter · C. Transmission confirmations | Page 1 of 1
Request · child of claim CLM-00048190
R-48190-03 · Harbor Imaging Center
- Draft
- Validating
- Ready
- Sent
- Acknowledged
- Invoice & payment
- Records in
- Verified
- Delivered
- Closed
No response in 32 days · 11 logged attempts
Reminders and a call are logged. Move it forward, or print the timestamped log if you need an order.
Move it forwardEvery action is written to the activity log.
Request details
Claim
CLM-00048190
Claimant
R. Example
Records requested
Any and all medical & billing records, incl. imaging
Days open
32
Sent as
Authorization (Ohio default)
First sent
Sep 28
Channel
Fax, then email
Fee
—
Validation
✓ Passed · identity and authorization confirmed
Activity 3
No response to 2 faxes and 2 emails in 14 days. Marked Stalled; Issue #14 opened.
Called (555) 010-4417. Film library backed up; left a voicemail.
Faxed request; line busy twice, sent by email instead.
Facility
Facility
Records Request Activity Log
Prepared on behalf of GOLD Life Claims Department
Request R-48190-03
Generated 10/30/2026 9:14 AM ET
Generated 10/30/2026 9:14 AM ET
| Claim number | CLM-00048190 | Records custodian | Harbor Imaging Center 88 Harbor Way, Dublin, OH 43017 |
|---|---|---|---|
| Claimant | R. Example | Custodian contact | Phone (555) 010-4417 · Fax (555) 010-4418 |
| Records requested | Any and all medical & billing records, incl. imaging | Authority for request | HIPAA authorization signed 08/20/2026 (Exhibit A) |
| First requested | 09/28/2026 | Days outstanding | 32 days as of 10/30/2026 |
Summary of attempts
| 4 faxes 2 delivered, 2 failed | 3 emails all delivered | 4 phone calls 2 voicemails left | 0 records received no release date given |
Chronological activity
| Date | Time (ET) | By | Method | Activity |
|---|---|---|---|---|
| 09/28/2026 | 9:02 AM | System | Fax | Request R-48190-03 faxed to (555) 010-4418 with signed authorization (4 pages). Result: line busy. |
| 09/28/2026 | 9:40 AM | System | Fax | Second fax attempt to (555) 010-4418. Result: line busy. |
| 09/28/2026 | 9:45 AM | System | Request and authorization emailed to front desk. Delivered. | |
| 10/01/2026 | 8:00 AM | System | Fax | Reminder 1 faxed with copy of original request. Delivered, 6 pages. |
| 10/06/2026 | 8:00 AM | System | Reminder 2 emailed. Delivered. | |
| 10/09/2026 | 3:30 PM | Marcus Chen (Processor) | Phone call | Called (555) 010-4417. Film library backed up. Left voicemail for records. |
| 10/12/2026 | 8:00 AM | System | Status | No response in 14 days. Request marked Stalled; Issue #14 opened. |
| 10/14/2026 | 10:15 AM | Ellen Park (Adjuster) | Phone call | Spoke with front desk (Maria). Request forwarded to the film library. No release date given. |
| 10/16/2026 | 8:00 AM | System | Fax | Reminder 3 faxed with copy of original request. Delivered, 6 pages. |
| 10/21/2026 | 2:05 PM | Ellen Park (Adjuster) | Phone call | No answer. Left voicemail with request number and callback number. |
| 10/24/2026 | 11:30 AM | Marcus Chen (Processor) | Emailed front desk asking for a records contact. No reply. | |
| 10/28/2026 | 9:10 AM | Ellen Park (Adjuster) | Phone call | Transferred twice; call dropped before reaching records. |
Automated entries are recorded by the system when the action occurs. User entries are recorded under the named user’s login with the date and time of entry. Entries cannot be edited or deleted after they are saved.
Prepared by: ______________________________
Title: ____________________
Date: ______________
Exhibits: A. Authorization · B. Original request letter · C. Transmission confirmations | Page 1 of 1
Request · child of claim CLM-00048213
R-48213-04 · Seabreeze Family Practice
- Draft
- Validating
- Ready
- Sent
- Acknowledged
- Invoice & payment
- Records in
- Verified
- Delivered
- Closed
No fax or email on file — can’t send
Add a records fax or email below. It saves to the Directory for everyone and sends this request.
Add a contact & sendSaved to the Directory and linked to this request; closes issue #13.
Request details
Claim
CLM-00048213
Claimant
Jordan Sample
Records requested
Any and all medical & billing records · 07/22/2026 – present
Days open
—
Sent as
Authorization (state default)
First sent
Not sent
Channel
—
Fee
—
Validation
✕ No facility fax or email — nothing to send to
Activity 2
No usable contact on file; request blocked. Issue #13 opened.
Added from an intake. Contact details missing.
Facility
Facility
Records Request Activity Log
Prepared on behalf of GOLD Life Claims Department
Request R-48213-04
Generated 10/30/2026 9:14 AM ET
Generated 10/30/2026 9:14 AM ET
| Claim number | CLM-00048213 | Records custodian | Seabreeze Family Practice No address on file |
|---|---|---|---|
| Claimant | Jordan Sample | Custodian contact | Phone — · Fax — |
| Records requested | Any and all medical & billing records · 07/22/2026 – present | Authority for request | HIPAA authorization signed 07/30/2026 (Exhibit A) |
| First requested | Not sent (blocked) | Days outstanding | — |
Summary of attempts
| 0 faxes no contact on file | 0 emails no contact on file | 0 phone calls — | 0 records received — |
Chronological activity
| Date | Time (ET) | By | Method | Activity |
|---|---|---|---|---|
| 10/12/2026 | 8:00 AM | System | Note | Added from an intake. No fax or email on file. |
| 10/12/2026 | 8:00 AM | System | Status | No usable contact; request blocked. Issue #13 opened. |
Automated entries are recorded by the system when the action occurs. User entries are recorded under the named user’s login with the date and time of entry. Entries cannot be edited or deleted after they are saved.
Prepared by: ______________________________
Title: ____________________
Date: ______________
Exhibits: A. Authorization · B. Original request letter · C. Transmission confirmations | Page 1 of 1
Request · child of claim CLM-00048213
R-48213-03 · Brightline Logistics
- Draft
- Validating
- Ready
- Sent
- Acknowledged
- Invoice & payment
- Records in
- Verified
- Delivered
- Closed
On trackAcknowledged by the facility. Next automatic reminder Oct 09 if no records arrive.
Request details
Claim
CLM-00048213
Claimant
Jordan Sample
Records requested
Wage and attendance records · 07/22/2025 – present
Days open
11
Sent as
Authorization
First sent
Oct 01
Channel
Email
Fee
No charge
Validation
✓ Passed · identity and authorization confirmed
Activity 2
Renee Ford: received, we’ll send payroll records by Friday.
Emailed request with the signed authorization.
Facility
Facility
Records Request Activity Log
Prepared on behalf of GOLD Life Claims Department
Request R-48213-03
Generated 10/30/2026 9:14 AM ET
Generated 10/30/2026 9:14 AM ET
| Claim number | CLM-00048213 | Records custodian | Brightline Logistics 4100 Commerce Dr, Columbus, OH 43219 |
|---|---|---|---|
| Claimant | Jordan Sample | Custodian contact | Phone (555) 010-7700 · Fax — |
| Records requested | Wage and attendance records · 07/22/2025 – present | Authority for request | HIPAA authorization signed 07/30/2026 (Exhibit A) |
| First requested | 10/01/2026 | Days outstanding | 11 days as of 10/30/2026 |
Summary of attempts
| 0 faxes — | 1 email delivered | 0 phone calls — | 0 records received promised by Friday |
Chronological activity
| Date | Time (ET) | By | Method | Activity |
|---|---|---|---|---|
| 10/01/2026 | 9:15 AM | System | Request R-48213-03 emailed with signed authorization. Delivered. | |
| 10/02/2026 | 11:20 AM | Brightline (Renee Ford) | “Received, we’ll send the payroll records by Friday.” |
Automated entries are recorded by the system when the action occurs. User entries are recorded under the named user’s login with the date and time of entry. Entries cannot be edited or deleted after they are saved.
Prepared by: ______________________________
Title: ____________________
Date: ______________
Exhibits: A. Authorization · B. Original request letter · C. Transmission confirmations | Page 1 of 1
Request · child of claim CLM-00048213
R-48213-01 · Northfield Regional Hospital
- Draft
- Validating
- Ready
- Sent
- Acknowledged
- Invoice & payment
- Records in
- Verified
- Delivered
- Closed
Records in212 pages are in Records Review. Missing dates detected; a follow-up for the remainder is prepared to send on accept.
Request details
Claim
CLM-00048213
Claimant
Jordan Sample
Records requested
Any and all medical & billing records · 07/22/2026 – present
Days open
5
Sent as
Authorization
First sent
Oct 01
Channel
Fax and email
Fee
None expected
Validation
✓ Passed · records matched to this request
Activity 2
212 pages received; sent to Records Review. Missing dates detected (08/31–present); follow-up prepared to send on accept.
Faxed request with the signed authorization.
Facility
Facility
Records Request Activity Log
Prepared on behalf of GOLD Life Claims Department
Request R-48213-01
Generated 10/30/2026 9:14 AM ET
Generated 10/30/2026 9:14 AM ET
| Claim number | CLM-00048213 | Records custodian | Northfield Regional Hospital 1200 Northfield Pkwy, Columbus, OH 43215 |
|---|---|---|---|
| Claimant | Jordan Sample | Custodian contact | Phone (555) 010-2200 · Fax (555) 010-2201 |
| Records requested | Any and all medical & billing records · 07/22/2026 – present | Authority for request | HIPAA authorization signed 07/30/2026 (Exhibit A) |
| First requested | 10/01/2026 | Days outstanding | 5 days as of 10/30/2026 |
Summary of attempts
| 1 fax delivered | 0 emails — | 0 phone calls — | 1 records received 212 pages |
Chronological activity
| Date | Time (ET) | By | Method | Activity |
|---|---|---|---|---|
| 10/01/2026 | 9:15 AM | System | Fax | Request R-48213-01 faxed with signed authorization. Delivered. |
| 10/06/2026 | 8:30 AM | System | Records | 212 pages received; sent to Records Review. Missing dates detected (08/31–present); follow-up prepared to send on accept. |
Automated entries are recorded by the system when the action occurs. User entries are recorded under the named user’s login with the date and time of entry. Entries cannot be edited or deleted after they are saved.
Prepared by: ______________________________
Title: ____________________
Date: ______________
Exhibits: A. Authorization · B. Original request letter · C. Transmission confirmations | Page 1 of 1
Request · child of claim CLM-00048190
R-48190-04 · Riverbend Urgent Care
- Draft
- Validating
- Ready
- Sent
- Acknowledged
- Invoice & payment
- Records in
- Verified
- Delivered
- Closed
VerifiedRecords are verified and ready to add to the claim packet.
Request details
Claim
CLM-00048190
Claimant
R. Example
Records requested
Any and all medical & billing records
Days open
7
Sent as
Authorization
First sent
Sep 28
Channel
Portal
Fee
$12.50 · paid through portal
Validation
✓ Passed · all checks cleared
Activity 2
6 pages received and verified.
Request sent through the records vendor portal.
Facility
Facility
Records Request Activity Log
Prepared on behalf of GOLD Life Claims Department
Request R-48190-04
Generated 10/30/2026 9:14 AM ET
Generated 10/30/2026 9:14 AM ET
| Claim number | CLM-00048190 | Records custodian | Riverbend Urgent Care 2040 Riverbend Rd, Grove City, OH 43123 |
|---|---|---|---|
| Claimant | R. Example | Custodian contact | Phone (555) 010-6630 · Fax (555) 010-6631 |
| Records requested | Any and all medical & billing records | Authority for request | HIPAA authorization signed 08/20/2026 (Exhibit A) |
| First requested | 09/28/2026 | Days outstanding | 7 days to records |
Summary of attempts
| 0 faxes portal | 0 emails portal | 0 phone calls — | 1 records received 6 pages, verified |
Chronological activity
| Date | Time (ET) | By | Method | Activity |
|---|---|---|---|---|
| 09/28/2026 | 9:05 AM | System | Portal | Request R-48190-04 submitted through the records vendor portal. |
| 10/05/2026 | 10:12 AM | System | Records | 6 pages received and verified. Fee $12.50 paid through the portal. |
Automated entries are recorded by the system when the action occurs. User entries are recorded under the named user’s login with the date and time of entry. Entries cannot be edited or deleted after they are saved.
Prepared by: ______________________________
Title: ____________________
Date: ______________
Exhibits: A. Authorization · B. Original request letter · C. Transmission confirmations | Page 1 of 1
Request · child of claim CLM-00048190
R-48190-01 · Northfield Regional Hospital
- Draft
- Validating
- Ready
- Sent
- Acknowledged
- Invoice & payment
- Records in
- Verified
- Delivered
- Closed
DeliveredDelivered to the claim packet on Oct 01. Kept here for the record.
Request details
Claim
CLM-00048190
Claimant
R. Example
Records requested
Any and all medical & billing records
Days open
—
Sent as
Authorization
First sent
Sep 28
Channel
Fax and email
Fee
Paid
Validation
✓ Passed · delivered and closed
Activity 2
84 pages delivered to the claim packet.
84 pages received and verified.
Facility
Facility
Records Request Activity Log
Prepared on behalf of GOLD Life Claims Department
Request R-48190-01
Generated 10/30/2026 9:14 AM ET
Generated 10/30/2026 9:14 AM ET
| Claim number | CLM-00048190 | Records custodian | Northfield Regional Hospital 1200 Northfield Pkwy, Columbus, OH 43215 |
|---|---|---|---|
| Claimant | R. Example | Custodian contact | Phone (555) 010-2200 · Fax (555) 010-2201 |
| Records requested | Any and all medical & billing records | Authority for request | HIPAA authorization signed 08/20/2026 (Exhibit A) |
| First requested | 09/28/2026 | Days outstanding | Delivered 10/01/2026 |
Summary of attempts
| 1 fax delivered | 0 emails — | 0 phone calls — | 1 records received 84 pages |
Chronological activity
| Date | Time (ET) | By | Method | Activity |
|---|---|---|---|---|
| 09/28/2026 | 9:00 AM | System | Fax | Request R-48190-01 faxed with signed authorization. Delivered. |
| 09/30/2026 | 2:00 PM | System | Records | 84 pages received and verified. |
| 10/01/2026 | 8:30 AM | System | Delivered | 84 pages delivered to the claim packet. |
Automated entries are recorded by the system when the action occurs. User entries are recorded under the named user’s login with the date and time of entry. Entries cannot be edited or deleted after they are saved.
Prepared by: ______________________________
Title: ____________________
Date: ______________
Exhibits: A. Authorization · B. Original request letter · C. Transmission confirmations | Page 1 of 1
New Request
Drop in the documents. We fill in the request.
Four quick steps. Nothing is sent until you preview it.
- 1Upload
- 2Confirm details
- 3Facilities
- 4Preview & send
No documents yet?
4 intakes are read and waiting to confirm
Arrived from your claim system, intake inbox and uploads — confirm to send the requests
intake-discovery.pdf · 3 ppgeneral-authorization.pdffacility-auth-lakeside.pdf
Claims intake · discovery notes · page 1 of 3
Claim: CLM-00048213 Line: Auto Date of incident: 07/22/2026
Claimant: Jordan Sample Sex: F DOB: 01/15/1985
Reported 07/23/2026 · Interview 08/10/2026 · Follow-up 10/15/2026
Treatment since incident: ER at Northfield Regional Hospital; orthopedic follow-up at Lakeside Orthopedic Clinic.
Prior treatment (5 yrs): family practice, Dr. Girard, Seabreeze Family Practice.
Employer: Brightline Logistics
Located fieldFacility found Zoom · full screen
Key details
Claimant name97%
Date of birth62%
Below your 90% threshold. Several dates on page 1 look similar.Gender91%
Claim number99%
Date of loss / incident95%
What to request is chosen for each facility on the next step.
More fields (5)
Signed general authorization found. Lakeside’s own authorization also detected.
Facilities found in the documents
Matched against your custodian directoryPossible duplicate: Northfield Regional already has an open request for Jordan Sample covering these dates (R-48213-01, sent Oct 01).
View R-48213-01Merge into itSend anywayNorthfield Regional Hospital
Health Information Mgmt · fax and email on file
Request
Lakeside Orthopedic Clinic
Records dept · fax on file · uses its own authorization (attached)
Request
Brightline Logistics
HR / payroll · email on file
Request
Seabreeze Family Practice (Dr. Girard)
No contact found in directory
Request
Not in the Directory — add it now
Is it one of these? Close matches already in the Directory:
Seabreeze Family Practice · no record found
Seaside Family Medicine · Dublin, OHUse this
Add “Seabreeze Family Practice” as a new facility
Only the essentials are required to send. The rest can be filled in later; the facility is saved to the Directory and linked to this request automatically.
Saved for everyone · appears in the Directory
St. Ambrose Medical CenterRecords · Columbus, OHAdd
St. Ambrose Medical Center – ImagingRadiology · Columbus, OHAdd
St. Ambrose Physicians GroupReleases via records vendorAdd
New facility
Only the essentials are required to send. Everything else can be added later. The facility is saved to the Directory and linked to this request automatically.
Auto-send when the directory match is 95% or higher
Off: you review every request before it’s sent. Your organization sets the threshold once match accuracy is proven.
Letters that will go out
Template: Medical records request · sends by fax
RE: Request #R-48213-01 · Claimant: Jordan Sample · DOB 01/15/1985 · Claim CLM-00048213
To the Custodian of Records, Northfield Regional Hospital:
Please provide copies of any and all medical and billing records for dates of service 07/22/2026 to present. A signed authorization is enclosed.
Please reply with the fee and expected release date, or a certificate of no records if none exist. Reference request #R-48213-01 on all replies and invoices.
GOLD Life Records Retrieval · records@goldlifeinsurance.com · Fax (555) 201-7700
Template: Medical records request + facility authorization · sends by fax
RE: Request #R-48213-02 · Claimant: Jordan Sample · DOB 01/15/1985 · Claim CLM-00048213
To the Custodian of Records, Lakeside Orthopedic Clinic:
Please provide copies of any and all medical and billing records for dates of service 07/22/2026 to present. A signed authorization is enclosed.
Please reply with the fee and expected release date, or a certificate of no records if none exist. Reference request #R-48213-02 on all replies and invoices.
GOLD Life Records Retrieval · records@goldlifeinsurance.com · Fax (555) 201-7700
Template: Employer wage & attendance request · sends by email
RE: Request #R-48213-03 · Claimant: Jordan Sample · DOB 01/15/1985 · Claim CLM-00048213
To Human Resources / Payroll, Brightline Logistics:
Please provide wage and attendance records from 07/22/2025 to present. A signed authorization is enclosed.
Please reply with the fee and expected release date, or a certificate of no records if none exist. Reference request #R-48213-03 on all replies and invoices.
GOLD Life Records Retrieval · records@goldlifeinsurance.com · Fax (555) 201-7700
What happens next
Today3 requests sent, with the authorization attached.
Every 3 business daysAutomatic reminders to each facility until it confirms.
After 14 days quietIt moves to “Delayed” and you’re alerted, with the facility’s phone number.
When records arriveChecked against this request, then waiting in Records to Review.
1 facility skipped: Seabreeze Family Practice has no contact yet. Add it any time from the claim folder.
Manual entry· no document uploaded
Key details
What to request is chosen for each facility on the next step.
Signed authorization
Attach the signed authorizationRequired before any request is sent.
You can save a draft now. Sending stays off until an authorization is attached.
Next you’ll add facilities and preview the letters.
⋮
Invoice overview
From
Amount
$42.50
Received
Oct 05 · email
Claim / request
CLM-00048133 · R-48133-01
Approver
Ellen Park (limit $500)
Payment status
Not yet paid · facility is holding records until paid
INVOICE
Northfield Regional Hospital
Due on receiptNorthfield Regional Hospital
Re: CLM-00048133
Search & retrieval fee$15.00
Copies, 110 pages × $0.20$22.00
Certification$5.50
Amount due$42.50
Sample invoice · no PHI
Approve this invoice
$42.50 goes to AP in the weekly batch file. Records release once the facility is paid.
Problem with this invoice
Invoice overview
From
Unknown sender
Amount
$62.50
Received
Oct 06 · invoices inbox
Claim / request
Not linked yet
Approver
Ellen Park (limit $500)
Payment status
Not yet paid · link the invoice to a request first
INVOICE
Unknown sender
Due on receiptUnknown sender
Re: (no claim reference)
Copies, 125 pages$62.50
Amount due$62.50
Sample invoice · no PHI
Approve this invoice
$62.50 goes to AP in the weekly batch file. Records release once the facility is paid.
Problem with this invoice
Invoice overview
From
Amount
$65.00
Received
Oct 02 · email
Claim / request
CLM-00048177 · R-48177-02
Approver
Ellen Park (limit $500)
Payment status
Not yet paid · awaiting approval
INVOICE
Harbor Imaging Center
Due on receiptHarbor Imaging Center
Re: CLM-00048177
Imaging reports$25.00
Images on disc$40.00
Amount due$65.00
Sample invoice · no PHI
Approve this invoice
$65.00 goes to AP in the weekly batch file. Records release once the facility is paid.
Problem with this invoice
Invoice overview
From
Amount
$18.00
Received
Oct 04 · fax
Claim / request
CLM-00048190 · R-48190-02
Approver
Ellen Park (limit $500)
Payment status
Paid Oct 08 · AP confirmation #AP-20417 · receipt on file
INVOICE
Lakeside Orthopedic Clinic
Due on receiptLakeside Orthopedic Clinic
Re: CLM-00048190
Records fee$18.00
Amount due$18.00
Sample invoice · no PHI
Approve this invoice
$18.00 goes to AP in the weekly batch file. Records release once the facility is paid.
Problem with this invoice
Upload invoice
For an invoice a facility sent straight to you instead of the shared inbox. It joins the queue and the Claim ID is read like any other invoice.
Recorded as Added manually by Ellen Park on the invoice and in the request activity log.
Intakes to confirm
Arrived from your claim system, intake inbox and uploads. The AI read each one; confirm to create and send the requests.CLM-00048244From claim system
intake-48244.pdf + authorization
Read · 5 of 5 key fields · ready to send
CLM-00048251Emailed to intake@goldlife
discovery-notes-48251.docx
Read · 4 of 5 key fields, 1 to check
CLM-00048263Provider list upload
provider-list-48263.xlsx · 6 providers listed
Read · 6 requests ready to create
CLM-00048270From claim system
deposition-transcript-48270.pdf · 84 pages
Read · 4 providers found in testimony
⋮
Delivery overview
Facility
Claim
CLM-00048213
Request
R-48213-01
Claimant
Jordan Sample
Date of birth
01/15/1985
Received
today · email · 212 pages
Fee
None expected
Still outstanding
08/31/2026 – present
AI summaryPlanned
- Emergency visit 07/22/2026 after the reported incident; discharged the same day.
- Two orthopedic follow-ups (07/29, 08/12) and a referral to physical therapy.
- Eight physical therapy sessions, 08/01 – 08/30.
- Itemized bill included; charges total $4,180 (sample).
Disclaimer: AI-generated. Verify against the source pages before relying on it.
1
2
3
4
5
Northfield Regional Hospital
Emergency Department Record
Copy · page 1Emergency Department Record
Patient: Jordan SampleDOB: 01/15/1985MRN: [sample]Date of service: 07/22/2026
Sample document · no PHI
Accept this delivery
The records join the claim packet for CLM-00048213 and the people below are notified.
Problem with this delivery
AI summary
Confidence: MediumA plain-language read of all 212 pages, with page citations. Verify against the source before relying on it.
- ER visit 07/22/2026 the day of the reported incident; left-shoulder and lower-back pain, imaging taken, discharged same day.pp. 1–2
- Orthopedic evaluation 07/29/2026 and follow-up 08/12/2026; diagnosis of lumbar strain, referred to physical therapy.pp. 3–40
- Eight physical therapy sessions 08/01–08/30/2026; steady improvement noted, discharge goals partly met.pp. 41–198
- Itemized bill totals $4,180 across ER, orthopedic and PT charges.pp. 199–211
- Custodian certification present and signed.p. 212
- Pages 14–18 read as mental-health counseling notes — likely need a separate authorization before release.pp. 14–18
Worth a look
- Records end 08/30/2026 but were requested through present — a remainder request is ready to send on accept.
- Possible mental-health pages (14–18) are held pending a separate authorization.
Answers cite the pages they come from.
AI-generated from the source pages. Not a clinical opinion. Confirm anything you rely on against the cited pages.
Delivery overview
Facility
Claim
CLM-00048177
Request
R-48177-02
Claimant
T. Demo
Date of birth
04/09/1971
Received
Oct 02 · fax · 38 pages
Fee
$65.00 · awaiting approval
Still outstanding
None
AI summaryPlanned
- Two imaging reports (pages 1–35) for the requested patient.
- Pages 36–38 excluded: patient mismatch.
Disclaimer: AI-generated. Verify against the source pages before relying on it.
1
2
3
4
5
Harbor Imaging Center
Radiology Report
Copy · page 1Radiology Report
Patient: T. DemoDOB: 04/09/1971MRN: [sample]Date of service: 09/03/2026
Sample document · no PHI
Accept this delivery
The records join the claim packet for CLM-00048177 and the people below are notified.
Problem with this delivery
Wrong-patient pages stay held back. Your privacy officer is notified and the incident process starts.
AI summary
Confidence: ReviewA plain-language read of all 38 pages, with page citations. Verify against the source before relying on it.
- Two radiology reports for T. Demo: left-knee MRI and lumbar spine X-ray, dated 09/03/2026.pp. 1–35
- Findings note a meniscal tear and mild degenerative changes; follow-up imaging suggested.pp. 1–35
- Pages 36–38 belong to a different patient (different name and DOB) and are held back, not included in this delivery.pp. 36–38
- No custodian certification was included with this delivery.—
Worth a look
- Pages 36–38 are a wrong-patient inclusion — held back; privacy incident #15 opened.
- Certification is missing; request it before accepting.
Answers cite the pages they come from.
AI-generated from the source pages. Not a clinical opinion. Confirm anything you rely on against the cited pages.
Delivery overview
Facility
Claim
CLM-00048190
Request
R-48190-04
Claimant
R. Example
Date of birth
06/30/1979
Received
Oct 05 · portal · 6 pages
Fee
$12.50 · paid through portal
Still outstanding
None
AI summaryPlanned
- Urgent care visit 09/02/2026; X-ray of the left wrist; follow-up advised.
Disclaimer: AI-generated. Verify against the source pages before relying on it.
1
2
3
4
5
Riverbend Urgent Care
Urgent Care Visit
Copy · page 1Urgent Care Visit
Patient: R. ExampleDOB: 06/30/1979MRN: [sample]Date of service: 09/02/2026
Sample document · no PHI
Accept this delivery
The records join the claim packet for CLM-00048190 and the people below are notified.
Problem with this delivery
AI summary
Confidence: HighA plain-language read of all 6 pages, with page citations. Verify against the source before relying on it.
- Single urgent-care visit 09/02/2026 for left-wrist pain after a fall.pp. 1–4
- Left-wrist X-ray taken; no fracture seen, soft-tissue swelling noted.pp. 5–6
- Advised rest, brace, and follow-up with orthopedics if pain persists.p. 4
- Visit notes and X-ray report both present and certified.pp. 1–6
Answers cite the pages they come from.
AI-generated from the source pages. Not a clinical opinion. Confirm anything you rely on against the cited pages.
Delivery overview
Facility
Claim
CLM-00048151
Request
R-48151-01
Claimant
M. Placeholder
Date of birth
11/21/1966
Received
Oct 02 · fax · 24 pages
Fee
$10.00 · paid
Still outstanding
None
AI summaryPlanned
- Initial evaluation 05/03/2026; 14 treatment visits through 09/26/2026.
- Discharge note included.
Disclaimer: AI-generated. Verify against the source pages before relying on it.
1
2
3
4
5
Pine Street Chiropractic
Chiropractic Treatment Notes
Copy · page 1Chiropractic Treatment Notes
Patient: M. PlaceholderDOB: 11/21/1966MRN: [sample]Date of service: 05/03/2026
Sample document · no PHI
Accept this delivery
The records join the claim packet for CLM-00048151 and the people below are notified.
Problem with this delivery
AI summary
Confidence: HighA plain-language read of all 24 pages, with page citations. Verify against the source before relying on it.
- Initial chiropractic evaluation 05/03/2026 for neck and upper-back pain.pp. 1–3
- Fourteen treatment visits 05/03–09/26/2026; spinal manipulation and therapeutic exercise.pp. 4–22
- Discharge note 09/26/2026: symptoms resolved, released to self-care.pp. 23–24
- Dates of service fall within the 05/01–09/30 requested range.pp. 1–24
Answers cite the pages they come from.
AI-generated from the source pages. Not a clinical opinion. Confirm anything you rely on against the cited pages.
Upload records
For records a facility sent straight to you, by email or on paper. They join the review queue and are checked like any other delivery.
Recorded as Added manually by Ellen Park on the delivery and in the request activity log.
Issue
#12 Lakeside can’t match the patient
AssigneesEllen Park (you) Add assignee
Due 2dTags:Invalid request data
Linked to
· · Lakeside Orthopedic Clinic
System opened this issue
Opened automatically Oct 04 when the facility’s reply was read as “no patient found.”
Closes automatically when the request is corrected and resent.
Add a comment
Issue
#13 Seabreeze Family Practice has no fax or email
AssigneesMarcus Chen (Processor) Add assignee
Due 1dTags:Missing facility contact
Linked to
· · Seabreeze Family Practice
System opened this issue
Opened automatically Oct 12 when validation found no usable contact.
Closes automatically when a fax or email is added in the Directory.
Add a comment
Issue
#14 No response from Harbor Imaging in 14 days
AssigneesMarcus Chen (Processor)Ellen Park (you) Add assignee
Due todayTags:Stalled request
Linked to
· · Harbor Imaging Center
System opened this issue
Opened automatically Oct 12 under your 14-day rule. Two faxes and two emails were sent.
Closes automatically when the facility responds.
Add a comment
Issue
#15 Wrong-patient pages in a Harbor Imaging delivery
AssigneesSofia Rivera (Adjuster)Privacy Officer Add assignee
Due 1dTags:Wrong-patient records
Linked to
· · Harbor Imaging Center
System opened this issue
Opened automatically Oct 02. Pages 36–38 are held back and not visible to anyone.
Closes when the facility confirms and the privacy officer signs off.
Add a comment
Issue
#16 Invoice for $62.50 has no Claim ID
AssigneesAP Team Add assignee
Due 3dTags:Unmatched invoice
Linked to
— · — · Unknown sender
System opened this issue
Opened automatically Oct 06 when no claim reference could be read.
Closes automatically when the invoice is linked to a request.
Add a comment
Issue
#17 Duplicate request held: Northfield already has an open request
AssigneesMarcus Chen (Processor) Add assignee
Due 1dTags:Duplicate request
Linked to
· · Northfield Regional Hospital
System opened this issue
Opened automatically Oct 13 when a new intake asked Northfield for the same claimant and dates already requested on R-48213-01.
Closes when the new request is merged into R-48213-01 or confirmed as different dates.
Add a comment
Issue
#18 Westgate Physical Therapy was acquired by St. Ambrose Physicians Group
AssigneesRecords team Add assignee
Due 3dTags:Facility acquired
Linked to
— · — · Westgate Physical Therapy
System opened this issue
Opened automatically Oct 14 when Westgate’s reply said its records are now held by St. Ambrose Physicians Group.
Closes when the Directory points Westgate to its successor and open requests are re-routed.
Add a comment
Issue
#19 Authorization on CLM-00048177 expires in 7 days
AssigneesSofia Rivera (Adjuster) Add assignee
Due 7dTags:Expiring authorization
Linked to
· · St. Ambrose Medical Center
System opened this issue
Opened automatically Oct 30 because the signed authorization expires before St. Ambrose’s usual turnaround.
Closes automatically when a new signed authorization is uploaded to the claim.
Add a comment
Unmatched · medrecords@stambrose.example
EM
medrecords@stambrose.example · Email · received Oct 06 4:15 pm
Re: records request for patient J. Sampel. Please confirm the date of birth before we release.
Couldn’t match
Suggested matches
R-48213-02 · Lakeside Orthopedic · Jordan Sample
87% matchSame DOB on the request; name spelled “Sampel”; sender domain differs from Lakeside
R-48177-03 · St. Ambrose · T. Demo
41% matchSender is St. Ambrose; no name or DOB match
None of these?Search requests·Mark as not ours
Log a call
Replies go from the shared records mailbox or fax line and are logged on the matched request.
EM
Pat Nguyen · records@lakeside.example · Email · received Oct 07 9:20 am
We have a Jordan Sample with DOB 01/16/1985, not 01/15. Should we release those records?
Facility has a question R-48213-02 · CLM-00048213
Waiting on your answer · linked to Issue #12
PH
Ellen Park · Phone call · sent Oct 07 11:05 am
Called Pat Nguyen. Confirmed they received our request; checking the DOB on our intake.
Call logged R-48213-02 · CLM-00048213
Logged on R-48213-02
FX
Lakeside records fax · Fax · received Oct 04 2:40 pm
No records found under the DOB provided for Jordan Sample.
No patient found R-48213-02 · CLM-00048213
Request marked Invalid · Issue #12 opened and assigned to you
EM
Pat Nguyen · records@lakeside.example · Email · received Sep 30 10:12 am
Records for R. Example attached (18 pages). Invoice to follow.
Records attached R-48190-02 · CLM-00048190
18 pages sent to Records to Review
Log a call
Replies go from the shared records mailbox or fax line and are logged on the matched request.
EM
him@northfield.example · Email · received Oct 06 8:30 am
Records attached, 212 pages. Remaining dates to follow.
Records attached R-48213-01 · CLM-00048213
212 pages sent to Records Review · missing dates detected, follow-up prepared
EM
billing@northfield.example · Email · received Oct 05 1:10 pm
Invoice attached for records request R-48133-01.
Fee due R-48133-01 · CLM-00048133
$42.50 sent to Invoices for approval
AI
AI call · Planned · AI call · sent Oct 03 10:02 am
Records desk confirmed the request was received. Estimated release in 5–7 business days.
Call logged R-48213-01 · CLM-00048213
Request moved to Acknowledged · transcript saved
FX
Records fax line · Fax · sent Oct 01 9:15 am
Records request R-48213-01 with signed authorization (4 pages).
Sent R-48213-01 · CLM-00048213
Delivered on first attempt
Log a call
Replies go from the shared records mailbox or fax line and are logged on the matched request.
SY
Follow-up rule · System · sent Oct 12 8:00 am
No response to two faxes and two emails in 14 days.
No response R-48190-03 · CLM-00048190
Request marked Stalled · Issue #14 opened for Marcus Chen
PH
Marcus Chen · Phone call · sent Oct 09 3:30 pm
Called (555) 010-4417. Front desk says the film library is backed up; left a voicemail.
Call logged R-48190-03 · CLM-00048190
Logged on R-48190-03
FX
Records fax line · Fax · sent Sep 28 9:02 am
Records request R-48190-03 with signed authorization.
Sent R-48190-03 · CLM-00048190
Fax line busy twice; sent by email instead
Log a call
Replies go from the shared records mailbox or fax line and are logged on the matched request.
EM
Renee Ford · hr-records@brightline.example · Email · received Oct 02 11:20 am
Received, we’ll send the payroll records by Friday.
Request received R-48213-03 · CLM-00048213
Request moved to Acknowledged
Log a call
Replies go from the shared records mailbox or fax line and are logged on the matched request.
Lookup
Find anything by anything.
Search by last name, date of birth, claim or matter number, request number or facility. Results are grouped into claimants, claims and requests.
Show
Try
More filters
9 results for Last name: Sample
Claimants 2
JS
Jordan Sample
DOB 01/15/1985 · F · 1 claim · 3 requests
RS
Riley Sample
DOB 03/02/1990 · M · 1 claim · 2 requests
Same last name, different DOB
Claims 2
CLM-00048213
Jordan Sample · Auto team · 3 requests
CLM-00047988
Riley Sample · Home team · 2 requests
Requests 5
| Request | Facility | Claim # | Claimant | Sent | Status |
|---|---|---|---|---|---|
| Northfield Regional Hospital | CLM-00048213 | Jordan Sample | Oct 01 | Records in, verifying | |
| Lakeside Orthopedic Clinic | CLM-00048213 | Jordan Sample | Oct 01 | Needs you: DOB mismatch | |
| Brightline Logistics | CLM-00048213 | Jordan Sample | Oct 01 | On track | |
| St. Ambrose Medical Center | CLM-00047988 | Riley Sample | Aug 04 | Delivered | |
| Westgate Physical Therapy | CLM-00047988 | Riley Sample | Aug 04 | Delivered |
6 results for DOB: 01/15/1985
Claimants 2
JS
Jordan Sample
DOB 01/15/1985 · F · 1 claim · 3 requests
JS
Jordan Sampel
DOB 01/15/1985 · F · Name read from a facility reply
Possible duplicate: same DOB, spelling differs
Claims 1
CLM-00048213
Jordan Sample · Auto team · 3 requests
Requests 3
| Request | Facility | Claim # | Claimant | Sent | Status |
|---|---|---|---|---|---|
| Northfield Regional Hospital | CLM-00048213 | Jordan Sample | Oct 01 | Records in, verifying | |
| Lakeside Orthopedic Clinic | CLM-00048213 | Jordan Sample | Oct 01 | Needs you: DOB mismatch | |
| Brightline Logistics | CLM-00048213 | Jordan Sample | Oct 01 | On track |
6 results for Claim #: CLM-00048190
Claimants 1
RE
R. Example
DOB 06/30/1979 · M · 1 claim · 4 requests
Claims 1
CLM-00048190
R. Example · Auto team · 4 requests · Matter M-2026-0117
Requests 4
| Request | Facility | Claim # | Claimant | Sent | Status |
|---|---|---|---|---|---|
| Northfield Regional Hospital | CLM-00048190 | R. Example | Sep 28 | Records verified | |
| Lakeside Orthopedic Clinic | CLM-00048190 | R. Example | Sep 28 | Records in, fee auto-approved | |
| Harbor Imaging Center | CLM-00048190 | R. Example | Sep 28 | Delayed: no response in 14 days | |
| Riverbend Urgent Care | CLM-00048190 | R. Example | Sep 28 | Records verified |
6 results for Facility: Lakeside Orthopedic
This search matched a facility.
Claimants 2
JS
Jordan Sample
DOB 01/15/1985 · F · Request to Lakeside: needs you
RE
R. Example
DOB 06/30/1979 · M · Request to Lakeside: records in
Claims 2
CLM-00048213
Jordan Sample · Auto team · 1 of 3 requests at Lakeside
CLM-00048190
R. Example · Auto team · 1 of 4 requests at Lakeside
Requests 2
| Request | Facility | Claim # | Claimant | Sent | Status |
|---|---|---|---|---|---|
| Lakeside Orthopedic Clinic | CLM-00048213 | Jordan Sample | Oct 01 | Needs you: DOB mismatch | |
| Lakeside Orthopedic Clinic | CLM-00048190 | R. Example | Sep 28 | Records in, fee auto-approved |
Tips: dates work as 01/15/1985 or 1/15/85. Partial names work, and close spellings are shown so duplicates are easy to spot. Searching “Anything” checks every field at once.
Northfield Regional Hospital
FAC00341
General
Facility name *
Northfield Regional Hospital
Last verified
Oct 02, 2026 · Records team
Records phone *
+1 (555) 010-2200
Records fax
+1 (555) 010-2201
Records email
him@northfield.example
Preferred request method
Records released by
Facility authorization form
Not required · general authorization accepted
Address
1200 Northfield Pkwy, Columbus, OH 43215
State
Time zone
Records department hours
Mon–Fri, 8:00–4:30
Groups
Facility status
Active
Authorization
Accepts a general authorization
Typical fees
Search $15 + $0.20 per page; certification $5.50
Records are released through the hospital’s records vendor portal. Requests still go to the hospital.
Contacts
DO (555) 010-2210dortiz@northfield.example
Dana Ortiz
HIM Manager
RO (555) 010-2200him@northfield.example
Release of Information desk
General records requests
Add a contact
Activity
12Requests, all time
3Open now
6 daysAvg. time to records
TodayLast activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| J. Sample | R-48213-01 | Oct 01 | Records in, verifying | 5 | |
| A. Testcase | R-48133-01 | Sep 19 | Fee awaiting approval | 16 | |
| New intake | R-48244-01 | Today | Sent | 0 | |
| K. Fixture | R-48102-02 | Sep 11 | Delivered | 8 |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Lakeside Orthopedic Clinic
FAC00342
General
Facility name *
Lakeside Orthopedic Clinic
Last verified
Sep 20, 2026 · Sofia Rivera
Records phone *
+1 (555) 010-3380
Records fax
+1 (555) 010-3381
Records email
records@lakeside.example
Preferred request method
Records released by
Facility authorization form
Facility-specific form on file · open template
Address
455 Lakeside Dr, Suite 200, Columbus, OH 43220
State
Time zone
Records department hours
Mon–Thu, 9:00–4:00
Groups
Facility status
Active
Authorization
Requires its own authorization form (template on file)
Typical fees
Flat $18 per request
Contacts
PN (555) 010-3385pnguyen@lakeside.example
Pat Nguyen
Records Coordinator
Add a contact
Activity
5Requests, all time
2Open now
9 daysAvg. time to records
Oct 07Last activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| J. Sample | R-48213-02 | Oct 01 | Needs you: DOB mismatch | 11 | |
| R. Example | R-48190-02 | Sep 28 | Records in, fee auto-approved | 7 |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Harbor Imaging Center
FAC00343
Fax failed twice this month. Call to confirm the fax number, then update it here.
General
Facility name *
Harbor Imaging Center
Last verified
Jun 14, 2026 · Records team
Records phone *
+1 (555) 010-4417
Records fax
+1 (555) 010-4418
Records email
Preferred request method
Records released by
Facility authorization form
Not required · general authorization accepted
Address
88 Harbor Way, Dublin, OH 43017
State
Time zone
Records department hours
Mon–Fri, 7:30–6:00
Groups
Facility status
Active
Authorization
Accepts a general authorization
Typical fees
Reports $25; images on disc $40
Contacts
FD (555) 010-4417—
Front desk
Ask for the film library
Add a contact
Activity
4Requests, all time
2Open now
18 daysAvg. time to records
Oct 06Last activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| R. Example | R-48190-03 | Sep 28 | Delayed: no response in 14 days | 14 | |
| T. Demo | R-48177-02 | Sep 24 | Wrong-patient pages flagged | 12 |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Pine Street Chiropractic
FAC00344
General
Facility name *
Pine Street Chiropractic
Last verified
Sep 22, 2026 · Records team
Records phone *
+1 (555) 010-5520
Records fax
+1 (555) 010-5521
Records email
office@pinestreetchiro.example
Preferred request method
Records released by
Facility authorization form
Not required · general authorization accepted
Address
310 Pine St, Westerville, OH 43081
State
Time zone
Records department hours
Mon–Fri, 9:00–5:00
Groups
Facility status
Active
Authorization
Accepts a general authorization
Typical fees
Flat $10 per request
Contacts
KA (555) 010-5520office@pinestreetchiro.example
Kim Alvarez
Office Manager
Add a contact
Activity
2Requests, all time
0Open now
4 daysAvg. time to records
Oct 02Last activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| M. Placeholder | R-48151-01 | Sep 22 | Delivered, paid | 10 |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Riverbend Urgent Care
FAC00345
General
Facility name *
Riverbend Urgent Care
Last verified
Aug 30, 2026 · Records team
Records phone *
+1 (555) 010-6630
Records fax
+1 (555) 010-6631
Records email
Preferred request method
Records released by
Facility authorization form
Not required · general authorization accepted
Address
2040 Riverbend Rd, Grove City, OH 43123
State
Time zone
Records department hours
Daily, 8:00–8:00
Groups
Facility status
Active
Authorization
Accepts a general authorization
Typical fees
Set by the portal; typically $6.50–$25
Records are released through a records vendor portal after payment.
Contacts
No named contacts yet.
Add a contact
Activity
3Requests, all time
1Open now
5 daysAvg. time to records
Oct 05Last activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| R. Example | R-48190-04 | Sep 28 | Records verified | 7 |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
St. Ambrose Medical Center
FAC00346
General
Facility name *
St. Ambrose Medical Center
Last verified
Oct 10, 2026 · Marcus Chen
Records phone *
+1 (555) 010-7100
Records fax
+1 (555) 010-7101
Records email
roi@stambrose.example
Preferred request method
Records released by
Facility authorization form
Not required · general authorization accepted
Address
900 Ambrose Blvd, Columbus, OH 43205
State
Time zone
Records department hours
Mon–Fri, 8:00–4:00
Groups
Facility status
Active
Authorization
Accepts a general authorization
Typical fees
Per state fee schedule
Contacts
RD (555) 010-7100roi@stambrose.example
ROI desk
Release of Information
Add a contact
Activity
1Requests, all time
1Open now
—Avg. time to records
TodayLast activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| New intake | R-48251-01 | Today | Sent | 0 |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Westgate Physical Therapy
FAC00347
General
Facility name *
Westgate Physical Therapy
Last verified
Jul 08, 2026 · Records team
Records phone *
+1 (555) 010-8250
Records fax
+1 (555) 010-8251
Records email
frontdesk@westgatept.example
Preferred request method
Records released by
Facility authorization form
Not required · general authorization accepted
Address
17 Westgate Ct, Hilliard, OH 43026
State
Time zone
Records department hours
Mon–Fri, 7:00–7:00
Groups
Facility status
Acquired by St. Ambrose Physicians Group · send new requests to the successor
Authorization
Accepts a general authorization
Typical fees
No charge under 50 pages
Contacts
No named contacts yet.
Add a contact
Activity
0Requests, all time
0Open now
—Avg. time to records
—Last activity
No requests have gone to this facility yet.
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Brightline Logistics
FAC00348
General
Facility name *
Brightline Logistics
Last verified
Sep 30, 2026 · Records team
Records phone *
+1 (555) 010-7700
Records fax
Records email
hr-records@brightline.example
Preferred request method
Records released by
Facility authorization form
Not required · general authorization accepted
Address
4100 Commerce Dr, Columbus, OH 43219
State
Time zone
Records department hours
Mon–Fri, 8:00–5:00
Groups
Facility status
Active
Authorization
Accepts a general authorization
Typical fees
No charge
Contacts
RF (555) 010-7712rford@brightline.example
Renee Ford
HR Generalist
Add a contact
Activity
3Requests, all time
1Open now
6 daysAvg. time to records
Oct 06Last activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| J. Sample | R-48213-03 | Oct 01 | On track, reminder sent | 11 | |
| K. Fixture | R-48102-05 | Sep 11 | Delivered | 6 |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Seabreeze Family Practice
FAC00349
Added from an intake on Oct 12, 2026. No contact details yet, so the request to this facility is on hold.
General
Facility name *
Seabreeze Family Practice
Last verified
Not yet verified
Records phone *
Records fax
Records email
Preferred request method
Records released by
Facility authorization form
Address
State
Time zone
Records department hours
Groups
Facility status
Active
Authorization
Typical fees
Contacts
DG ——
Dr. Girard
Physician (from intake)
Add a contact
Activity
1Requests, all time
1Open now
—Avg. time to records
Oct 12Last activity
| Claim # | Claimant | Request | Sent | Status | Days open |
|---|---|---|---|---|---|
| J. Sample | — | Not sent | On hold: missing contact details | — |
Every request to this facility across all claims, with its status. Spot slow facilities, and fix contact details once for everyone.
Reports
The numbers that prove it is working.
Avg. turnaround9.0 dayssent → records in, this month
90th percentile21 days9 of 10 arrive within
First-pass success68%no issue on first try
Faster vs. May53% down from 19.0 days
Turnaround time by month
Average days from request sent to records receivedMay19 days8 requests
Jun16 days11 requests
Jul14 days14 requests
Aug12 days16 requests
Sep11 days18 requests
Oct9 days19 requests
Trending down as the custodian directory and follow-up rules mature.
Where requests leak 25
Issues opened this month, by type.
No response from facility9
Invalid or expired authorization4
Wrong-patient pages2
Wrong records sent3
Partial records5
Unmatched invoice2
Follow-up effort
How many reminders each request needed. Work the automation removes from your team.
No reminder needed6
1 reminder5
2 reminders4
3+ reminders3
Escalated to a call4
Suggested subpoena1
Open requests19across 6 claims
Needs you3over a limit, stalled or invalid
Over 30 days3oldest is 32 days
Open issues82 assigned to you
Aging
Open requests by days outstanding0–7 days7
8–14 days5
15–30 days4
Over 30 days3
Anything over 30 days is a candidate for a call or a subpoena. The escalation ladder acts on these automatically.
Where requests sit now
Count at each stage of the lifecycle.
Sent18
Acknowledged14
Invoice & payment9
Records in7
Verified5
Delivered4
Workload by person
Open requests and issues per user, to balance the load.
Ellen Park (you)6 open2 issues
Sofia Rivera5 open1 issue
Marcus Chen (Processor)7 open3 issues
AP Team3 invoices1 unmatched
Fastest custodianPine Street4-day average
Slowest custodianHarbor Imaging18-day average, subpoena candidate
Need a contact update2Harbor Imaging, Seabreeze
Acquired / closed1Westgate → St. Ambrose
Facility scorecard
Ranked by average turnaround| Facility | Avg. turnaround | Response rate | Follow-up % | Issues | Rating |
|---|---|---|---|---|---|
| 4 days | 0% | 0 | Preferred | ||
| 5 days | 0% | 0 | Preferred | ||
| 6 days | 33% | 0 | Preferred | ||
| 6 days | 25% | 1 | Preferred | ||
| 9 days | 40% | 1 | Watch | ||
| — | — | 0 | No history | ||
| 18 days | 100% | 2 | Watch |
Built from every request across all claims. Use it to set alert thresholds in the Directory and to decide when to go straight to a subpoena.
Awaiting approval$107.502 invoices · plus 1 in manual review
Approved, at AP$18.001 invoice
Paid$10.001 invoice
Saved by fee checks$40.00over-limit charges caught
Spend by claim
| Claim # | Matter # | Claimant | Requests | Awaiting | Paid | Total |
|---|---|---|---|---|---|---|
| — | T. Demo | 3 | $65.00 | $0.00 | $65.00 | |
| M-2026-0098 | A. Testcase | 2 | $42.50 | $0.00 | $42.50 | |
| M-2026-0117 | R. Example | 4 | $0.00 | $18.00 | $18.00 | |
| — | M. Placeholder | 2 | $0.00 | $10.00 | $10.00 | |
| — | K. Fixture | 5 | $0.00 | $0.00 | $0.00 | |
| — | J. Sample | 3 | $0.00 | $0.00 | $0.00 | |
| Total | $107.50 | $28.00 | $135.50 | |||
Fee variance
Invoices checked against the state fee cap and expected range.
| Facility | Amount | Finding | Action |
|---|---|---|---|
| Harbor Imaging Center | $65.00 | $40.00 images not requested | Flagged for review |
| Unknown sender | $62.50 | $0.50/page over expected | On hold, needs Claim ID |
| Northfield Regional | $42.50 | Within limits | Needs approval |
Cost per claim & per page
Trended, to test the platform-fee model.
Avg. cost per claim$22.58
Avg. cost per page$0.19
Refunds requested$65.001 open
Refunds recovered$0.00none yet
Sensitive-record flags2handled per state rules
Privacy incidents1wrong-patient, open 1 day
Avg. incident resolution1.5 daysfrom flag to sign-off
Access events loggedevery viewdownload, print, share
Sensitive records
Mental health, substance-use and HIV/STD pages| Claim / request | Facility | Type | Handling |
|---|---|---|---|
| CLM-00048213 · R-48213-01 | Northfield Regional | Mental health · pp. 14–18 | Held for review; separate authorization flagged |
| CLM-00048177 · R-48177-02 | Harbor Imaging | Wrong-patient · pp. 36–38 | Held back; incident opened (#15) |
Access log
Who viewed, downloaded or shared recordsPlanned| User | Action | Records | When |
|---|---|---|---|
| Ellen Park | Viewed | Northfield records, CLM-00048213 | Today 9:14 AM |
| Sofia Rivera | Downloaded | Harbor Imaging reports, CLM-00048177 | Oct 02 3:40 PM |
| Defense counsel | Viewed via link | Riverbend records, CLM-00048190 | Oct 05 11:02 AM |
| Privacy Officer | Viewed held pages | Harbor Imaging pp. 36–38 | Oct 02 4:15 PM |
A complete, exportable access trail for a carrier’s security review. Separate from the request activity log.
System Settings
Set it up once for how your team works.
Organization administrators manage these. Users only see their own preferences.
Users, roles and approval limits
| User | Role | Teams they can see | Invoice Approval Limit |
|---|---|---|---|
| Ellen Park (you) | Adjuster | Auto | $500 |
| Sofia Rivera | Adjuster | Auto, Home | $500 |
| Marcus Chen | Processor | All teams | View only |
| AP Team | Accounts payable | All teams | $5,000 |
| Claims Supervisor | Supervisor | All teams | $2,500 |
Invoices above a user’s limit route to the next approver. Under $25 is auto-approved.
Follow-up rules
Auto-send at 95% directory match
Off until match accuracy is proven
Escalation ladder
What happens when a facility goes quiet. Every step is written to the request’s activity log.
1
Aftercreate a call task for
2
Afteralert
3
Aftersuggest a subpoena or court order and prepare the activity log
Notifications
Only include items that need me
Email me for every new record
Most teams leave this off and use the summary.
Identifiers
Claim number
Shown on every request and letter
Rename
Example: “Claim number” to “Claim #” or “File number”
Client matter number
Used by outside counsel
Rename
Example: “Claim number” to “Claim #” or “File number”
Case number
Turn on once suits are filed
Rename
Example: “Claim number” to “Claim #” or “File number”
Renaming changes the label everywhere your team sees it: screens, letters, exports and the claim packet.
Shared inboxes and AP
Retention
Remind me 7 days before a claim is purged
Export all records
Every claim’s records, letters, invoices and activity logs in one download, organized by claim.
Large exports are prepared in the background. You’ll get an email with a secure download link.
State Specific Settings
Each state’s rules, set once and applied to every request.
Requests to facilities in a state use that state’s wording, delivery method and forms automatically. Users can still change them on a single request.
Sample values for this demo. Each customer confirms its state rules with counsel before go-live.
Request wording
Subpoenas and delivery
Authorizations and certification
Fees, timing and defaults
Last reviewed Oct 12, 2026 by Org Admin
Integration
Claim system export
Name *
Claim system export
Used by Claims, Invoices
Sends the completed claim packet to the claim system
SQLAutomation StudioREST API
Endpoint
https://[claim-system].example/api/v1
Authentication
[API KEY stored securely]
Field mapping
| claim.id | → | ClaimNumber |
| claimant.name | → | ClaimantName |
| packet.zip | → | Documents[] |
| request.id | → | ExternalReference |
Visible to administrators only.
Integration
AP batch file
Name *
AP batch file
Used by Claims, Invoices
Weekly approved-invoice file for accounts payable
SQLAutomation StudioREST API
Endpoint
https://[claim-system].example/api/v1
Authentication
[API KEY stored securely]
Field mapping
| claim.id | → | ClaimNumber |
| claimant.name | → | ClaimantName |
| packet.zip | → | Documents[] |
| request.id | → | ExternalReference |
Visible to administrators only.
Integration
eFax
Name *
eFax
Used by Records Request, Correspondence
Sends records requests by fax and receives facility replies and records
Provider
eFax Corporate (API)
Account number
[eFax account # stored securely]
API base URL
https://secure.efaxcorporate.com/api/v2
Authentication
[API key / token stored securely]
Outbound — sending requests
Send-from fax number
+1 (555) 201-7700
Caller ID name
GOLD Life Records
Cover sheet
GOLD Life cover with request # barcode
Retry on failure
3 attempts, 30 minutes apart
Resolution
Fine (200 dpi)
Delivery confirmation
Status webhook → logged to the request activity
Inbound — receiving replies & records
Inbound fax number (DID)
+1 (555) 201-7701
How inbound faxes arrive
Monitored inbox
records@goldlifeinsurance.com
Inbound webhook URL (if used)
https://app.goldlifeinsurance.com/hooks/efax-inbound
File format
PDF · OCR on arrival
Webhook signature
[shared secret stored securely]
Auto-match inbound to a request by
Cover-sheet request # / barcode, then sender fax number
Inbound faxes land in the monitored inbox (records@goldlifeinsurance.com) and are matched to the open request automatically. Anything that can’t be matched goes to Correspondence for manual matching.
Visible to administrators only.
Integration
Custodian portal retrieval
Name *
Custodian portal retrieval
Used by Claims, Invoices
Downloads released records from records vendor portals
SQLAutomation StudioREST API
Endpoint
https://[claim-system].example/api/v1
Authentication
[API KEY stored securely]
Field mapping
| claim.id | → | ClaimNumber |
| claimant.name | → | ClaimantName |
| packet.zip | → | Documents[] |
| request.id | → | ExternalReference |
Visible to administrators only.
Audit log
Every touch, on every claim, request, invoice and record.
A complete, tamper-evident trail for compliance and carrier security reviews. Entries can’t be edited or deleted. This is the system-wide view of the same activity shown on each claim and request.
| Date / time (ET) | By | Object | Reference | Action |
|---|---|---|---|---|
| Oct 30 9:14 AM | Ellen Park Adjuster | Request | Logged: tried calling hospital again today. | |
| Oct 30 9:02 AM | System Automated | Claim | Duplicate request held (#17): Northfield already open for these dates. | |
| Oct 29 4:45 PM | Ellen Park Adjuster | Request | Private note added (not in court log). | |
| Oct 28 9:10 AM | Ellen Park Adjuster | Request | Call logged: transferred twice, call dropped. | |
| Oct 14 2:00 PM | Sofia Rivera Adjuster | Record | Viewed held pages 36–38 (wrong-patient). | |
| Oct 13 11:20 AM | AP Team Accounts payable | Invoice | Approved $18.00 and sent to AP. | |
| Oct 12 8:00 AM | System Automated | Request | Marked Stalled; Issue #14 opened. | |
| Oct 10 3:05 PM | Org Admin Administrator | Settings | Changed request wording to “Subpoena.” | |
| Oct 08 10:40 AM | AP Team Accounts payable | Invoice | Payment confirmed #AP-20417. | |
| Oct 07 11:05 AM | Ellen Park Adjuster | Request | Call logged with Lakeside about DOB mismatch. | |
| Oct 06 8:30 AM | System Automated | Record | 212 pages received; sent to Records Review. | |
| Oct 05 1:10 PM | System Automated | Invoice | Invoice $42.50 received; routed for approval. | |
| Oct 02 4:15 PM | Privacy Officer Compliance | Issue | Wrong-patient pages held; incident opened. | |
| Oct 01 9:15 AM | Ellen Park Adjuster | Claim | Sent 4 requests from uploaded intake. | |
| Sep 28 9:02 AM | Ellen Park Adjuster | Request | Request created and sent to Harbor Imaging. |
Showing the 15 most recent of 2,480 entries this period. Automated entries are recorded by the system; user entries under the named user’s login. Nothing here can be edited or removed.
Demo extras
What your team would see, and what’s coming next.
Weekly summary to the adjuster
From Records Retrieval
To Ellen Park
Subject Your week: 18 requests in flight, 3 need you
Here’s where your requests stand this Friday.
14On track
1Delayed
3Need you
4New records
You’ll be signed in automatically. Change how often you get this in Settings.
To facilities
From records@goldlifeinsurance.com
To him@northfield.example
Subject Records request #R-48213-01 · Jordan Sample · Claim CLM-00048213
Please find attached our request for records and the signed authorization.
Reply to this email with the fee and expected release date, or a certificate of no records. Please include request #R-48213-01.
From records@goldlifeinsurance.com
To records@lakeside.example
Subject Reminder: records request #R-48213-02
We sent a request for records on 10/01/2026 and haven’t received a response. Please reply with the status, fee, or anything else you need.
Roadmap
Now · version 1.0Upload and confirm, letters, email and fax follow-up, reply reading, invoices and AP, records verification, claim packet export
NextAI summaries and “Ask about these records” · retrieval from custodian portals · a broader custodian directory
LaterOrdering records from inside your claim system and delivering them straight back · AI phone calls for receipt confirmation, with identity safeguards
Help us tailor it
- Should every request and reply use one shared mailbox (for example records@), or separate ones for invoices?
- How do invoices get approved today, and what limits do adjusters and supervisors have?
- How should approved invoices reach AP, and how are new custodians set up as vendors?
- Would your team ever need to create an invoice for its own records when a custodian doesn’t send one?
- Which identifiers do your teams use: claim number, client matter number, case number?