Pear Suite’s AI Documentation & Notes Review
An overview of how Pear Suite’s AI review checks documentation for common billing requirements and note quality.
Table of Contents
To help Community Health Workers and organizations get claims approved more smoothly, Pear Suite now includes an AI-powered documentation review tool that checks activities for common billing requirements before claims are submitted.
This tool acts as a built-in quality check, helping ensure activities have the documentation needed for successful reimbursement.
Our goal is simple: help you spend less time fixing claims and more time supporting your community.
How it Works
Pear Suite’s documentation review happens in two stages to help catch issues early and support successful billing.
First, the system checks that required documentation elements are present when an activity is marked as billable. Then, after the claim is generated, an additional AI-assisted review evaluates the overall quality and completeness of the activity note.
This two-step process helps ensure that activities meet both basic billing requirements and documentation quality standards before claims move forward.
Documentation Requirement Check
When an activity is completed and marked as billable, Pear Suite automatically reviews the documentation to confirm that required elements are present.
The system may check for things like:
- A note being included with the activity
- Documentation meeting minimum note requirements
- Duplicate notes across activities
- Required documentation tied to health plan requirements
If something appears to be missing, the platform will notify you so it can be corrected before billing occurs.
This helps prevent issues that could delay or deny reimbursement.
Documentation Quality Review
After a claim is generated, Pear Suite performs an additional AI-assisted review of the documentation to evaluate the overall quality and completeness of the note.
This review looks for indicators that the documentation reflects a valid and meaningful service interaction, helping organizations identify notes that may require additional clarification before billing.
If potential issues are identified, the activity will be placed in Compliance Hold so the documentation can be reviewed or updated before the claim proceeds.
What Admins Should Know
If an activity requires additional review, the claim for the activity will temporarily be placed on a Compliance Hold.
Admins do not need to take action within the Compliance tool itself, but you may see indicators on the “Claims” page and will need to coordinate with your CHWs if documentation updates are required.
Claims Page
If an activity is undergoing a compliance review, the claim will display an error message: “Compliance audit in progress.”
This means:
- The activity documentation is being reviewed and may need to be updated
- Billing for the activity is on hold
This hold ensures that claims submitted to health plans meet documentation standards and reduces the risk of claim denials.
Expected Review Turnaround Time
Most compliance reviews are completed within a business day of the activity.
If the activity passes review:
- The compliance hold on the claim is automatically removed
- The claim proceeds through the normal billing workflows
If the activity does not meet documentation requirements:
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The CHW who completed the activity will receive several notifications to update documentation
- An in-platform notification will appear under their Notifications bell outlining identified issues
- An email notification outlining the identified issues and a direct link to the member’s profile
- The activity with the compliance hold will be highlighted on the Member Profile, indicating a compliance hold is in place.
After the CHW updates the activity documentation, the AI Compliance Tool will automatically run again.
If the activity meets compliance requirements:
- The compliance hold on the claim will be removed and the claim will move forward through the normal billing workflow
- The compliance indicator on the Member Profile will be removed
Supporting Your CHWs
Encourage CHWs to write clear, thorough, and accurate Member Notes for activities with members to avoid compliance reviews.
Documentation of the services is a requirement for all CALAIM services.
Admin can support compliance by regularly and routinely tracking claims with Compliance Holds and ensuring CHWs review the feedback and complete all required documentation as soon as possible so billing is not delayed.
What CHWs Should Know
Compliance Notifications and Activity Updates
Pear Suite’s Compliance Tool checks activity notes to make sure they meet documentation requirements before claims move forward for billing.
If an activity that is submitted for claim reimbursement does not meet compliance requirements, the system will send a compliance notification and place the related claim on Compliance Hold until the issue is resolved.
This process helps prevent billing errors and ensures documentation meets required standards.
Receiving a Compliance Notification
If an activity does not meet compliance requirements, the user who completed the activity will receive an in-platform notification
The notification will include an explanation of why the activity did not pass compliance review.
Common reasons include:
- The activity note is missing
- The activity note is below the minimum required length
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The note does not include enough detail about the service provided
When this happens, the claim connected to the activity is placed on Compliance Hold. Claims on Compliance Hold cannot move forward to billing until the documentation issue is resolved.
Updating the Activity Note
Most compliance issues can be resolved by updating the activity note with additional information.
To update the activity:
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Open the member profile using the link provided in the notification.
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Locate the activity that was flagged for compliance.
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Select Edit Activity.
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Update the activity note with the required information.
- Select Update Activity.
After the activity note is updated, the compliance check will run automatically again.
If the activity meets the required standards, the claim will be able to move forward.
Frequently Asked Questions
What is the AI Documentation Review tool?
The AI Documentation Review tool helps identify missing or incomplete information in activity documentation before it is submitted for billing. It analyzes case notes and documentation fields to ensure required information is included so that claims meet compliance and billing requirements.
This helps organizations catch issues early, reducing the risk of claim denials and/or compliance issues.
Who uses the AI Documentation Review tool?
The AI review supports multiple users across the Pear Suite platform:
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Community Health Workers (CHWs): Receive real-time alerts if required documentation elements are missing or incomplete.
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Supervisors and administrators: Can review compliance insights and documentation quality before claims are submitted.
When does the AI review documentation?
The AI review occurs when an activity is completed or updated.
If required elements are missing, the tool will put a temporary compliance hold on the activity for review. If the review identifies missing or incomplete documentation, a user will receive a notification in the Pear Suite platform with the identified compliance issues and reviewer feedback.
What kinds of issues does the AI tool detect?
The AI tool helps identify documentation gaps such as:
- Missing required fields in note templates
- Incomplete case notes
- Missing information required for billing compliance
By catching these issues early, the tool helps ensure documentation aligns with billing and compliance standards.
Does the AI tool replace documentation reviews by supervisors?
No. The AI tool supports documentation review but does not replace supervisor oversight.
Supervisors, QA staff, and operations teams should still review documentation as part of their quality assurance and compliance processes.
The AI tool acts as an early warning system to improve documentation quality before claims are submitted.
Will the AI change or edit my documentation?
No. The AI tool does not edit or change documentation.
It only provides alerts if information appears to be missing or incomplete so the user can update their documentation before completing the activity.
What should I do if I receive a compliance hold alert?
If you receive a notification of a compliance hold for an activity you completed:
- Review the message to understand what information is missing.
- Update the activity note or required fields.
- Confirm the documentation is accurate and reflects the service provided.
- Update the activity.
Updating the activity will prompt the AI documentation review tool to run again. If the updated documentation meet compliance requirements, the compliance hold will be removed from the activity and a claim will be generated for billing.
How does this tool help prevent billing issues?
Incomplete or inconsistent documentation is one of the most common reasons claims are delayed or denied.
By identifying missing documentation elements before an activity is finalized, the AI Documentation Review tool helps organizations:
- Improve documentation accuracy
- Reduce rejected claims
- Maintain compliance with payer requirements
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Strengthen audit readiness
Does this tool help with audits?
Yes. By encouraging complete and consistent documentation, the AI Documentation Review tool helps organizations maintain records that support billing and compliance reviews.
This improves preparedness for internal audits, payer audits, and regulatory reviews.
Still have questions?
Contact Pear Suite Support for assistance.