Discharge planning and post-acute placement
How do we run discharge planning and post-acute placement so the patient's choice is captured, the clinical packet and the authorization go to the facilities, and acceptances are tracked until placement?
Run the placement as a parallel request to the facilities the patient chose. When a discharge to post-acute care is planned, Callvu prefills the patient's clinical summary, the coverage and the needs from the EHR, classifies the level of care and the eligible facilities (the payer's network, the geography, the specialty needs, the quality data the rule requires the hospital to share), presents the choice to the patient or their representative with the list and the quality information, sends the packet to the chosen facilities in parallel through their links, chases their acceptances on a clock, obtains the payer's authorization for the level of care, routes a refusal pattern, a coverage gap or a patient who cannot choose to the case manager in the Decision Desk, and writes the placement, the acceptance and the transfer details to the EHR with the discharge summary sent to the receiving facility.
In scopeComplex: multi-party handoffsCallvu moves: prefill, classify, chase and verify, decide, write back
Last updated November 7, 2026.
The problem today
The case manager faxed the packet to six nursing facilities one at a time and the patient stayed two extra days waiting for the first to say no.
A patient ready to leave the hospital for a skilled nursing facility, a rehabilitation unit or home health is a patient whose bed is needed and whose outcome depends on the next setting. The case manager builds a packet, calls or faxes facilities, waits for each answer, and in the meantime chases the payer's authorization. The patient and the family are asked to choose from a list they do not understand, and the discharge summary follows later.
The discharge planning conditions of participation require the hospital to assess needs, to involve the patient and the representative in the plan, to provide a list of the available post-acute providers that participate in the patient's program and serve the area, to share the quality and resource use data, to respect the patient's choice and document it, and to send the necessary medical information to the receiving provider at the time of transfer. The payer requires an authorization for the level of care. The acceptance is a chase against several facilities, which is best done in parallel.
A placement requested from every chosen facility at once, with the authorization running alongside, is a discharge that happens on the day the patient is ready.
How it runs
From the requestto the system of record.
A discharge to a post-acute setting is planned (the care team flags the need, or the expected discharge date approaches with a post-acute need). Callvu opens the placement.
- Patient or representative
- Reviews the list and the quality data, states their choice and preferences on their phone or a bedside screen, and signs the choice.
- Case manager or discharge planner
- Assesses the needs, confirms the level of care and decides exceptions in the Decision Desk.
- Post-acute facilities and agencies
- Receive the packet through their links and accept or decline with a bed date.
- Payer
- Authorizes the level of care.
- Callvu
- Prefills, classifies the level of care and the facilities, captures the choice, sends and chases, obtains the authorization, routes and writes.
Prefill and classify
The clinical summary (the diagnoses, the functional status, the therapy needs, the medications, the equipment, the isolation status), the coverage and the home situation are prefilled from the EHR; the needs classify the level of care (skilled nursing, inpatient rehabilitation, long-term acute care, home health, hospice) and the eligible facilities from the payer's network, the geography and the specialty needs, with the quality and resource use data the rule requires.
Capture the choice
The patient or their representative is shown the list with the quality data and the distance in plain terms, states their preferences and their choice of facilities (several, ranked), is told of any financial interest the hospital has in a listed provider, and signs the choice on their phone or a bedside screen; a patient without capacity and without a representative on file goes to the case manager in the Decision Desk.
Chase and verify acceptances and the authorization
The packet (the clinical summary, the therapy evaluations, the medication list, the coverage, the expected discharge date) is sent to the chosen facilities in parallel through their links, each is chased on the clock with the case showing who has answered, and their acceptances or declines with a bed date and any condition are captured; the payer's authorization for the level of care is requested through the prior authorization process in parallel and tracked; a refusal pattern (every facility declining for a reason the hospital can address), a coverage gap, or a facility condition goes to the case manager in the Decision Desk with only the allowed outcomes.
Decide, place and write back
The case manager confirms the placement with the patient from the acceptances (the patient's first choice that accepted with a bed on the discharge date), the transfer is arranged with the transport and the receiving contact, the discharge summary and the necessary medical information are sent to the receiving facility at transfer, and the placement, the acceptance, the authorization and the transfer details are written to the EHR with the patient's signed choice.
Where it ends: The patient chose from a list with the quality data, the chosen facilities answered in parallel, the authorization ran alongside, and the EHR holds the placement with the choice, the acceptance and the information sent at transfer. The Decision Trace shows the level of care, the list and any decision; the Audit Trace shows the choice, each facility's response and the transfer with time.
Runtime enforcement
What is enforcedwhile the work runs.
The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.
The handoff
Between the front doorand the back office.
The front door
The patient or representative on their phone or a bedside screen; the facilities through their links.
The back office
The case manager sees every facility's answer and the authorization on one case and decides only exceptions.
The Decision Desk
- A patient without capacity and without a representative, a refusal pattern, a coverage gap or a facility condition goes to the case manager in the Decision Desk with the case and only the allowed outcomes.
Proof
In scope.Proof at scale, not one process at a time.
The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.
23 hospitals in the Ministry of Health network run on Callvu.
Across Callvu customers
More than 1,000 processes are live across Callvu customers.
Across Callvu customers
Questions
What buyers ask next,answered plainly.
How is the patient's choice handled?
The patient or representative sees the list of participating providers with the quality data and the distance, states and signs their choice, and is told of any financial interest the hospital has; the choice is in the EHR.
Are facilities contacted one at a time?
No. The packet goes to every chosen facility at once through their links, each is chased, and the case shows who has accepted with a bed date.
What goes to the receiving facility?
The discharge summary and the necessary medical information at the time of transfer, as the conditions of participation require, sent from the record.
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