When finishing a Pathway, the CHW reads the PCHI eligibility criteria displayed directly in the Pathway workflow. These criteria explain what PCHI considers a completed Pathway for that specific Pathway type. The CHW then makes a determination: completed or incomplete. Once they select the closure status that matches the outcome, the platform fires the corresponding supervisor review request template. There is no automatic determination by the system. The CHW’s closure status selection is the single trigger for generating the appropriate supervisor review request.

[Screenshot Placeholder: Pathway Closure Status Options Showing PCHI Eligibility Criteria]Accordion Body

Each Pathway contains two preconfigured supervisor review request templates. If the CHW selects a closure status that aligns with PCHI’s definition of successful access to the referred resource or appointment, a completed review request fires to the supervisor. If the CHW selects an incomplete or unsuccessful closure status, an incomplete review request fires instead. These templates help supervisors quickly understand member outcomes and what type of review is required before the Pathway can be finalized.

[Screenshot Placeholder: Completed vs Incomplete Review Request Templates]

Supervisors manage all incoming review requests from the Review Request page. On this page, supervisors can see the member associated with each request, along with the Pathway and the CHW-selected closure status displayed in the Review Request column title. Each request includes a status indicator so supervisors immediately know whether the request is ready for review, awaiting additional information, or has been rejected. Supervisors can filter the list by request type, request status, or assigned reviewer to manage their workload efficiently.

When a supervisor clicks a review request, a modal opens displaying a clear description of the request, including whether the CHW designated the Pathway as completed or incomplete. The modal also contains a direct link to the Care Pathway so supervisors can review all documentation, activities, and notes associated with that Pathway before making a decision.

If the supervisor agrees with the CHW’s designation, they select Submit and Approve:

• For completed Pathways:
  Submitting and approving opens a scheduling modal where the supervisor schedules the Supervisor Review Notes and billing activity. This is where the supervisor documents their review and completes the billing action required to generate a claim for PCHI.
• For incomplete Pathways:
  Supervisors leave their notes directly on the review request modal itself. No downstream activity is created, no scheduling is required, and no billing occurs.

Supervisors may also take the following actions:

• Reject:
  If the CHW assigned the wrong closure status, the supervisor rejects the request. The request updates to Rejected, and the supervisor works with the CHW to assign the correct closure status so an accurate review request can fire.
• Request Additional Info:
  If more information is needed, the supervisor selects Request Additional Info and leaves clarity notes. The request updates to Additional Info Requested (orange). The CHW will see this in the Review Request section of the member’s profile and can open the modal, review the supervisor’s notes, and respond accordingly.

[Screenshot Placeholder: Review Request Page – Supervisor View]
[Screenshot Placeholder: Supervisor Review Request Modal]

Only completed Pathways result in billing. When a supervisor approves a completed review request, the platform generates and schedules the Supervisor Review Notes and billing activity tied to that Pathway. This activity contains the supervisor’s notes and is the required billing step to generate a claim for PCHI.

For incomplete Pathways, supervisors leave their review notes directly in the review request modal when approving. No downstream activity is generated because incomplete Pathways are not billable under PCHI requirements, and no claim is created.

[Screenshot Placeholder: Supervisor Review Notes Activity Scheduling Modal]