Getting started
Overview
Trowel runs AI-powered workflows for healthcare operations. It processes documents, checks them against your requirements, and routes important or uncertain decisions to people on your team.
Key concepts
- Workflow: a series of steps Trowel runs on each item, such as a claim packet or new-hire file.
- Requirements: the fields, documents, and checks that define a complete item.
- Review rules: when an item goes to a person, and to whom.
- Audit history: a read-only record of every step and decision.
Getting started
Set up your workspace
A workspace holds your workflows, team members, and settings. Most organizations use one workspace per operations group.
Steps
- Sign in with your work email or single sign-on.
- Name your workspace and choose your time zone.
- Invite team members and assign roles.
- Optionally install Trowel Desktop for drag-and-drop intake.
Getting started
Your first workflow
Start from a template such as Pre-Claim Review or Document Processing, then adjust it to match how your team works.
Recommended approach
- Choose one high-volume, well-understood workflow.
- Upload 10–20 de-identified sample documents.
- Review the test results with the people who do the work today.
- Adjust requirements and review rules, then turn the workflow on.
Use de-identified sample documents while configuring a workflow.
Workflows
Workflow templates
Templates give you a starting set of steps, requirements, and review rules for common healthcare workflows.
Available templates
- Pre-Claim Review
- Document Processing
- Employee Onboarding
- Compliance Review
- Missing Information Detection
- Human Review queue
Workflows
Requirements and checks
Requirements tell Trowel what a complete, consistent item looks like.
Types of requirements
- Required documents, such as an authorization or operative report.
- Required fields, such as member ID or date of service.
- Consistency checks across documents, such as matching dates of birth.
- Format and range checks, such as a valid NPI or an unexpired license.
When a requirement is not met, Trowel marks the item as missing information or needs review and lists the specific gap.
Workflows
Human review rules
Review rules decide which items go to a person. Missing documents and inconsistencies always go to review.
Common rules
- Field confidence below a threshold you set.
- A specific document type is missing.
- Values conflict between documents.
- Item type or value requires specialist review.
Reviewer actions
- Approve
- Edit and approve
- Request information
- Reject
Pre-Claim Review
Pre-Claim Review workflow
Pre-Claim Review checks a home health chart before you submit the pre-claim review request to your Medicare Administrative Contractor (MAC). Trowel runs six steps on every chart and stops for a person whenever something is missing, inconsistent, or can’t be verified.
The six steps
- Review chart documents
- Verify document completeness
- Reconcile key information across documents
- Validate against readiness rules
- Generate the readiness assessment and report
- Save the audit workpaper and rule matrix
Item statuses
- Processing: Trowel is working through the steps.
- Missing information: a required document, page, signature, or date is absent.
- Needs review: a value conflicts, confidence is low, or a rule couldn’t be checked.
- Ready: every required rule passed.
- Ready with warnings: required rules passed, but advisory rules flagged something worth a look.
- Not ready: one or more required rules failed. Do not submit yet.
- Saved: the workpaper and rule matrix are stored with the item’s audit history.
An item only moves forward on its own when every check passes. Anything uncertain goes to a reviewer. Trowel never submits to the MAC for you.
Pre-Claim Review
1. Review chart documents
Trowel splits the chart into individual documents, identifies each one, and reads the fields later steps need.
What went well
- You upload the chart, or it arrives by email, shared folder, or API.
- Multi-document PDFs are split, and each document is classified: referral, face-to-face encounter, plan of care (CMS-485), OASIS start-of-care assessment, orders, and visit notes.
- Key fields are extracted with a confidence score and a link to the source page.
- All documents are recognized and readable, so the item moves to completeness.
When something goes wrong
A page is blurry, skewed, or faxed at low resolution
Needs review- What Trowel does
- Marks fields from that page as low confidence and highlights them.
- What you do
- Confirm or correct the values against the page, or upload a clearer scan.
A file is password-protected or corrupted
Processing stops- What Trowel does
- Can’t open the file and shows “Unreadable file” on the item.
- What you do
- Remove the password or re-export the file, then upload it again.
A document can’t be classified
Needs review- What Trowel does
- Labels it “Unclassified” instead of guessing.
- What you do
- Pick the document type. Trowel then extracts its fields and continues.
The chart contains another patient’s document
Needs review- What Trowel does
- Flags the document because its name, date of birth, or MBI doesn’t match the rest of the chart.
- What you do
- Remove the document from this item. It’s logged in the audit history.
The same document appears twice
Continues- What Trowel does
- Keeps the most complete copy and marks the other as a duplicate.
- What you do
- Nothing, unless the copies differ. Then choose which one to keep.
Pre-Claim Review
2. Verify document completeness
Trowel checks that every document your requirements call for is present, complete, signed, and dated.
What went well
- Trowel compares the chart with the required documents for the episode type.
- Each required document has all its pages, plus the signatures and dates it needs.
- Optional documents are noted when present.
- Nothing is missing, so the item moves to reconciliation.
When something goes wrong
A required document is missing
Missing information- What Trowel does
- Lists the exact document, for example “Face-to-face encounter note not found”.
- What you do
- Upload the document, or request it from the referring practitioner using Request information.
A document is unsigned or undated
Missing information- What Trowel does
- Points to the signature or date field that’s blank.
- What you do
- Obtain the signed, dated version and upload it. Trowel re-runs the check automatically.
Pages are missing, such as page 2 of 4
Missing information- What Trowel does
- Detects the gap in page numbering and names the missing pages.
- What you do
- Upload the complete document.
An optional document is absent
Continues- What Trowel does
- Notes it as a warning only.
- What you do
- Nothing required. Add it if your agency’s policy expects it.
Pre-Claim Review
3. Reconcile key information across documents
Trowel compares the facts that must agree across the chart, so a mismatch is caught before the MAC sees it.
What Trowel compares
- Patient name, date of birth, and Medicare Beneficiary Identifier (MBI)
- Start of care date and certification period
- Certifying practitioner and NPI
- Primary and secondary diagnoses (ICD-10) on the OASIS and the plan of care
- Face-to-face encounter date and the practitioner who performed it
What went well
- Each value is collected from every document that contains it.
- All sources agree, or differ only in formatting, such as “03/04/1948” and “Mar 4, 1948”.
- Trowel records one reconciled value per field, with links to every source.
- The item moves to rule validation.
When something goes wrong
Values conflict, such as two different dates of birth
Needs review- What Trowel does
- Shows each value next to its source page.
- What you do
- Choose the correct value and add a note. If a source document is wrong, have it corrected and re-uploaded.
Start of care differs between the OASIS and the plan of care
Needs review- What Trowel does
- Flags both dates because the certification period and the face-to-face window depend on them.
- What you do
- Confirm the correct start of care with your clinical team before continuing.
Diagnoses don’t match between the OASIS and the plan of care
Needs review- What Trowel does
- Lists the codes that appear in one document but not the other.
- What you do
- Have coding review the codes and update the source document.
A field appears in only one document
Continues- What Trowel does
- Uses that value and notes it has a single source.
- What you do
- Nothing, unless your review rules require two sources for that field.
Pre-Claim Review
4. Validate against readiness rules
Readiness rules check the reconciled chart against Medicare home health requirements and your agency’s own policies.
Examples of readiness rules
- The face-to-face encounter happened within 90 days before or 30 days after the start of care.
- The encounter was performed by an allowed practitioner and relates to the primary reason for home health.
- Homebound status and the need for skilled services are documented.
- The plan of care is signed and dated by the certifying practitioner.
- The OASIS start-of-care assessment was completed within 5 days of the start of care.
- The certifying practitioner’s NPI is valid and enrolled in PECOS.
Each rule is either required (a failure blocks readiness) or advisory (a failure adds a warning). Your administrator chooses which.
What went well
- Trowel evaluates every active rule against the reconciled values.
- Each rule records Pass, with the evidence it used.
- All required rules pass, so the item moves to the readiness assessment.
When something goes wrong
A required rule fails, such as a face-to-face encounter outside the window
Not ready- What Trowel does
- Records the failure, the values it compared, and the source pages.
- What you do
- Fix the underlying documentation, for example by obtaining a valid encounter, then re-run validation.
An advisory rule fails
Ready with warnings- What Trowel does
- Records a warning but doesn’t block readiness.
- What you do
- Review the warning and decide whether to address it before submitting.
A rule can’t be checked, such as when the PECOS lookup is unavailable
Needs review- What Trowel does
- Marks the rule “Unable to verify”. It never treats this as a pass.
- What you do
- Verify the rule manually and record the result, or re-run the check once the service is back.
Narrative documentation is ambiguous, such as homebound status
Needs review- What Trowel does
- Quotes the relevant text and explains why the evidence is unclear.
- What you do
- Decide whether the documentation supports the rule. Your decision and note are kept in the audit history.
Rules change while an item is in progress
Continues- What Trowel does
- Finishes the item on the rule version it started with, and notes that version in the report.
- What you do
- Re-run validation if you want the item checked against the new rules.
Pre-Claim Review
5. Generate the readiness assessment and report
Trowel summarizes the chart’s readiness in one report your team can act on and keep.
What the report includes
- The overall result: Ready, Ready with warnings, or Not ready
- Every rule with its result, the evidence it used, and the source pages
- Reconciled patient, episode, and practitioner details
- Open issues, each with the action needed and who owns it
- Reviewer decisions and notes made along the way
What went well
- All required rules pass.
- Trowel generates the report with the result Ready.
- A reviewer opens the report, confirms it, and approves the item.
- Your team submits the pre-claim review request to the MAC, and the item moves on to saving.
When something goes wrong
The result is Not ready
Not ready- What Trowel does
- Lists each failed rule with the fix it needs and the owner it’s assigned to.
- What you do
- Work the open issues. Uploading a corrected document re-runs the affected steps and creates a new report version.
A reviewer disagrees with a rule result
Needs review- What Trowel does
- Lets the reviewer override the result only with a written reason. Overrides are marked in the report.
- What you do
- Make sure overrides follow your agency’s policy. They can’t be hidden or removed later.
The report fails to generate
Processing- What Trowel does
- Retries automatically and keeps all results from earlier steps.
- What you do
- Wait a few minutes. If it still fails, create a support request with the item ID.
New documents arrive after the report was generated
Processing- What Trowel does
- Re-runs the affected steps and creates a new report version. Earlier versions are kept.
- What you do
- Review the new version before submitting.
Pre-Claim Review
6. Save the audit workpaper and rule matrix
Trowel stores a permanent record of what was checked, what was found, and who decided what.
What gets saved
- The audit workpaper: a PDF of the readiness report plus every reviewer decision and note
- The rule matrix: each rule’s version, result, evidence, and source pages, as a CSV
- A fingerprint (SHA-256 hash) of both files, recorded in the access audit chain
What went well
- Once the item is approved, Trowel generates the workpaper and the rule matrix.
- Both files are saved read-only with the item.
- Their fingerprints are added to the audit chain.
- The item status changes to Saved, and the files can be exported for a MAC request or an HHSC survey.
When something goes wrong
Saving fails, for example because storage is unavailable
Processing- What Trowel does
- Retries automatically. The item can’t show Saved until both files are stored and fingerprinted.
- What you do
- Nothing at first. If the item stays in Processing for more than an hour, create a support request.
Someone needs to change a saved item
Saved- What Trowel does
- Never edits saved files. Re-opening the item creates a new version with its own workpaper.
- What you do
- Re-open the item from its history and record the reason.
A saved file’s fingerprint no longer matches
Saved, flagged- What Trowel does
- Shows a chain integrity warning in the access audit.
- What you do
- Contact Trowel Support right away. Don’t rely on that copy until it’s verified.
Workpapers and rule matrices are kept for 6 years, in line with your audit retention policy.
Documents
Uploading documents
Send work to Trowel by upload, Trowel Desktop, email forwarding, shared folders, or API.
Supported formats
- PDF (including scanned and faxed)
- TIFF
- JPEG and PNG
- DOCX
Multi-document packets are split automatically and each document is classified separately.
Administration
Roles and permissions
Role-based access controls what each person can see and do.
Default roles
- Administrator: manages settings, users, and integrations.
- Manager: configures workflows and views analytics.
- Reviewer: works the review queue for assigned workflows.
- Viewer: read-only access to results and history.
Single sign-on with SAML or OIDC is available on Professional and Enterprise plans.
Administration
Audit history
Each item has a read-only audit history of automated steps, views, edits, and decisions.
Open any item and select History to see its timeline. Administrators can export audit history for internal review.
Administration
Integrations
Receive work from existing systems and send structured results back.
Options
- Email forwarding and shared folders
- SFTP
- REST API and webhooks
- EHR and custom integrations on Enterprise plans
Administration
Troubleshooting
If an item stops processing, check these common causes first.
- The source file is password-protected or corrupted.
- A required connection, such as a shared folder, is unavailable.
- The workflow was paused by an administrator.
- The item is waiting on human review.
Still stuck? Create a support request from the Help Center and include the item ID.