Sentinel
The right status, before admission.
Sentinel screens a patient's level of care before the admission status is set: transparent, criteria-traced utilization-management screening anchored in CMS's Two-Midnight Rule, with a licensed clinician making every determination.
What it does
Medical-necessity and level-of-care denials are decided at the door: long before a claim exists. Sentinel screens admissions, continued stays, and discharge readiness against a physician-governed criteria library, with CMS's Two-Midnight Rule as the Medicare backbone and the Inpatient-Only list applied automatically. Every recommendation carries its full criteria trace (never a bare verdict) and anything uncertain routes to a physician advisor. Sentinel screens; your licensed clinicians decide.
Capabilities
- Admission, continued-stay, and discharge-readiness screening
- Two-Midnight Rule (42 CFR 412.3) overlay with the CMS Inpatient-Only list
- Full criteria trace on every recommendation - transparent, auditable logic
- Physician-advisor governance - criteria are inactive until a physician signs off
- CMS NCD/LCD coverage references with a refreshable content pipeline
How it works
Screen
Each review runs a severity-of-illness / intensity-of-service rollup with the Two-Midnight payment overlay and the CMS Inpatient-Only shortcut: before the status is set.
Trace
Every recommendation ships with the exact criteria it relied on. Uncertain cases route to secondary review by a physician advisor; nothing auto-denies, ever.
Decide
A licensed clinician makes the determination and records it in your UR system of record; Sentinel keeps de-identified metrics and a tamper-evident governance ledger.
Why it matters
A level-of-care denial voids an entire stay's reimbursement, and status changed after discharge is revenue you rarely recover. Screening at the door (with logic your physicians approved and can inspect) prevents the denial instead of litigating it, and keeps every determination in licensed human hands.
Security & compliance
Sentinel is built PHI-free by design - clinical inputs are evaluated in memory and never persisted; only de-identified metrics and a hash-chained audit and governance ledger are stored. It operates as transparent, non-device clinical decision support: it recommends with a criteria trace, and a licensed clinician owns every determination. Every Paladyn tool is built toward HITRUST and SOC 2.
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