The Revenue Integrity Hub provides billing staff and practice administrators with the tools to find claims that may not hold up in an audit before they are billed. Each day, ThoroughCare reviews the claims created the day before against the documentation requirements for their program and assigns each claim an audit risk. The results appear directly in the ‘Billing and Claims’ screen, along with a checklist that explains what passed and what needs attention. In this section, you will learn how to read the ‘Revenue Integrity’ card on the Command Center, how claims are audited, how to use the ‘Audit Risk’ column to find and sort claims, how to review a claim’s audit details, and how to approve a flagged requirement after review.
Revenue Integrity Card
The ‘Revenue Integrity’ card is located on the ‘Command Center’ screen. It displays claims that may need attention before they are billed, grouped by audit risk, along with claims that cannot move forward until missing information is added. To learn more about the Command Center, please see the ‘Command Center’ section.
Risk Identified - This count displays the number of claims with a ‘Ready to bill’ status that have an identified audit risk.
Needs Review - This count displays the number of claims with a ‘Ready to bill’ status that need a closer review.
Low Risk - This count displays the number of claims with a ‘Ready to bill’ status that have a low audit risk.
Missing Info Claims - This count displays the number of claims with a ‘Missing info’ status.
Notes:
This card counts claims, not patients.
This card only counts claims for the practice the user is currently working in, even when ‘All’ is selected. To view another practice’s claims, switch to that practice.
Some practices limit billing and claims access to certain roles. When this setting is on, only users associated with the ‘Super Admin’, ‘Practice Admin’, ‘Customer Admin’, or ‘Billing Admin’ user role, or users with the ‘Claims Submit’ permission, will see the card’s counts. All other users will see an ‘Access restricted for your role’ message.
To view claims for a count through the ‘Command Center’ screen:
Click the desired count on the ‘Revenue Integrity’ card to open the ‘Billing and Claims’ screen with the matching filters applied
Notes:
The ‘Risk Identified’, ‘Needs Review’, and ‘Low Risk’ counts apply the ‘Status’ and ‘Audit Risk’ filters. The ‘Missing Info Claims’ count applies the ‘Status’ filter only.
Each count on the card matches the number of claims in the list it opens.
Billing and Claims
The ‘Billing and Claims’ screen lists the claims generated for a practice. When the Revenue Integrity Hub is turned on, this screen also displays an ‘Audit Risk’ column that shows the result of each claim’s audit. Users can sort and filter claims by audit risk, then open any claim’s audit details to see which documentation requirements were met and which need attention.
To access the ‘Billing and Claims’ screen through the left side panel:
Expand ThoroughCare’s left side panel
Click ‘Billing and Claims’
Notes:
The ‘Billing and Claims’ screen can also be opened from the ‘Revenue Integrity’ card on the Command Center.
The ‘Audit Risk’ column is only displayed for organizations that have the Revenue Integrity Hub turned on. To learn more about adding the Revenue Integrity Hub, please reach out to a ThoroughCare representative for assistance.
The ‘Billing and Claims’ screen displays claims for the practice you are currently working in.
How Claims Are Audited
ThoroughCare audits claims once a day. Each morning, it reviews every eligible claim created the day before and checks it against the documentation requirements for its program. Each requirement is reviewed using the patient’s chart, care plan, time logs, and other information in ThoroughCare. The results of all requirements are combined into a compliance percentage, which determines the claim’s audit risk.
Risk Identified - The claim’s compliance percentage is 58% or lower. There is clear evidence that one or more requirements are not met, or documentation is missing.
Needs Review - The claim’s compliance percentage is above 58% and up to 75%. Some requirements are partly met, inconsistently documented, or could not be fully verified.
Low Risk - The claim’s compliance percentage is above 75%. The requirements are met and supporting documentation is present.
Processing - The claim has not been audited yet.
Error - The audit could not be completed for the claim. The reason is displayed in the claim’s audit details.
Notes:
Each claim is audited once, the day after it is created. Claims are audited even when their billing month is still open, and they are not audited again at the end of the month.
If a claim is deleted and a new claim is created for the same patient, the new claim is audited the day after it is created.
Claims are audited against the billing month they belong to.
Revenue Integrity audits are available for Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) claims.
Navigating the ‘Audit Risk’ Column
The ‘Audit Risk’ column is the first column in the ‘Billing and Claims’ worklist. Its header displays as a dark navy pill with the TC Compass icon. Each claim in the column displays a colored audit risk pill.
Risk Identified - Red
Needs Review - Yellow
Low Risk - Green
Processing - Gray
Sorting by Audit Risk
Sorting by audit risk lists the claims that most need attention first.
To sort claims by audit risk through the ‘Billing and Claims’ screen:
Click the ‘Audit Risk’ column header to sort claims from ‘Risk Identified’ to ‘Low Risk’
Note: Click the header again to reverse the order. Claims without an audit result are listed last.
Filtering by Audit Risk
The ‘Audit Risk’ filter narrows the worklist to claims with one or more audit risk levels.
To filter claims by audit risk through the ‘Billing and Claims’ screen:
Open the worklist filters
Click into the ‘Audit Risk’ filter to display the audit risk levels
Select one or more of the following: ‘Risk Identified’, ‘Needs Review’, ‘Low Risk’, or ‘Processing’
Note: When more than one level is selected, claims with any of the selected levels are displayed.
Showing, Hiding, and Moving the ‘Audit Risk’ Column
The ‘Audit Risk’ column can be hidden or moved like other columns on the ‘Billing and Claims’ screen.
To hide or show the ‘Audit Risk’ column through the ‘Billing and Claims’ screen:
Click ‘Column Visibility’ located above the worklist on the left
Uncheck ‘Audit Risk’ to hide the column, or check it to show the column
To move the ‘Audit Risk’ column through the ‘Billing and Claims’ screen:
Click ‘Arrange Columns’ located above the worklist on the left
Drag ‘Audit Risk’ to the desired position
Click the ‘Save’ button
Notes:
Column settings are remembered the next time the screen is opened.
CSV and PDF exports of the worklist include the ‘Audit Risk’ column in the same position, unless it is hidden.
Reviewing a Claim’s Audit Details
Each claim’s audit details explain why it received its audit risk. The audit details display every requirement that was checked, grouped into sections, with a green check for requirements that were met, a red X for requirements that carry risk, and an explanation for each requirement that was flagged.
To review a claim’s audit details through the ‘Billing and Claims’ screen:
Locate the desired claim and click its pill in the ‘Audit Risk’ column to open the claim’s audit details
Review the claim’s audit risk and compliance percentage at the top of the modal
Review each section’s requirements and the explanation listed under each flagged requirement
Notes:
The top of the modal displays the date of the audit and the program, such as ‘Audit run: November 9, 2026 · Program: CCM’.
If the claim has not been audited yet, the modal displays ‘This claim has not yet gone through the daily audit review.’
If the audit could not be completed, the modal displays the reason.
CCM Audit Requirement Sections
CCM claims are checked against requirements in the following sections:
Patient Eligibility, Initiating Visit & Consent - Requirements such as an initiating visit with the billing provider, eligible chronic conditions, and documented consent.
Comprehensive Patient-Centered Care Plan - Requirements such as a care plan for each managed condition, documented goals and interventions, medication management, and offering the care plan to the patient.
Ongoing Comprehensive Care Management - Requirements such as a designated care manager, ongoing monitoring, care coordination, patient engagement, and follow-up on care transitions.
Service Elements, Time & Billing Integrity - Requirements such as complete time logs, meeting the minimum monthly time, supervision by the billing provider, and time that is not counted twice across programs.
Program Oversight & Risk Indicators - Requirements such as unusual time log patterns.
Approving a Flagged Requirement
After reviewing a flagged requirement, a user can approve it as met and add a note explaining why. The claim’s audit risk and compliance percentage are then updated. The original audit result is kept, so both the original result and the current result are displayed.
To approve a flagged requirement through the ‘Billing and Claims’ screen:
Locate the desired claim and click its pill in the ‘Audit Risk’ column to open the claim’s audit details
Click the flagged requirement to display the note field
Enter a note explaining why the requirement is met
Click the ‘Approve’ button to save
Note: To exit without saving, click the ‘Cancel’ button. The ‘Approve’ button stays disabled until a note is entered.
Notes:
An approved requirement is displayed as met, along with its note, the user who approved it, and when it was approved.
The top of the modal displays the ‘Original System Result’ and the ‘Current Risk Status’, along with the user who last updated the claim and when.
The pill in the ‘Audit Risk’ column and the ‘Audit Risk’ filter update to match the claim’s current risk status.
Only requirements that were flagged can be approved. An approval cannot be undone at this time.
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