> ## Documentation Index
> Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt
> Use this file to discover all available pages before exploring further.

# Care Management Worklist — User Guide

> How to review, approve, and void care-management billing charges on the worklist.

# Care Management Worklist — User Guide

## What Is the Worklist?

The **Care Management Worklist** is the billing review queue for monthly care-management charges that have passed all gate checks but are awaiting manual submission (when auto-post is OFF). It shows:

* Patient name and enrollment program (CoCM / BHI / CCM / PCM)
* Accrued minutes vs. threshold
* CPT code selected by the engine
* Gate status and any denial reasons
* Payer policy and covered-code badge

***

## Navigating the Worklist

**Path:** PM → Care Management → Worklist

The default view shows the current month's enrollments. Use the month picker to review prior months.

**Filters:**

* **Program** — filter by CoCM, BHI, CCM, or PCM
* **Gate Status** — pass / fail / denied / pending
* **Provider** — filter by billing provider
* **Payer** — filter by payer name

***

## Actions

### Submit a Charge

1. Select one or more rows with gate status **Pass**.
2. Click **Submit to Billing**.
3. The charge is created in `pm_charges` with the pre-evaluated CPT code and sent to the billing queue.

### Review a Denied Charge

1. Click the row to expand the detail panel.
2. The **Denial Reason** shows exactly why the gate failed (e.g., `concurrent_billing:conflicting_code=99484`, `registry_membership_missing`, `credential_gate_fail`).
3. Coordinate with the clinical team or correct the underlying issue, then re-trigger evaluation from the **Evaluate** button.

### Void a Charge

Voiding cancels a previously auto-posted charge and records an immutable audit entry.

1. Click the row for an auto-posted charge.
2. Click **Void Charge**.
3. Enter a void reason (required for audit trail).
4. Confirm. The charge status becomes `void` and the billing period gate status becomes `void`.

**Important:** Void entries cannot be deleted. They satisfy NFR-audit-1 (100% evaluation coverage in the audit log).

***

## Understanding Gate Statuses

| Status      | Meaning                                    | Action                              |
| ----------- | ------------------------------------------ | ----------------------------------- |
| **Pass**    | All gates passed; charge is ready          | Submit or confirm auto-posting      |
| **Fail**    | Time or threshold gate failed              | Review accrued minutes              |
| **Denied**  | Policy / credential / registry gate denied | See denial reason; resolve upstream |
| **Void**    | Charge was voided after posting            | No action needed                    |
| **Pending** | Evaluation not yet run for this month      | Will run at month-end or on-demand  |

***

## Audit Trail

Every gate evaluation — pass, fail, or void — creates an immutable audit row in `pm_care_mgmt_gate_audit`. The audit row includes:

* Verdict (pass / fail / void)
* Denial reason if applicable
* Rule snapshot (exact code-family rules, payer policy, credential check result used at evaluation time)

The audit log is **insert-only**. No row can be updated or deleted, satisfying NFR-audit-1 and SC-002.

***

## Related Resources

* [Time Logging User Guide](care-management-time-logging-user-guide.md)
* [Care Management Admin Guide](care-management-admin-guide.md)
* [PM-75 Billing Integration Reference](../architecture/integrations/PM-75-CARE-MANAGEMENT-BILLING-INTEGRATION.md)