Rules engine

When Incident severity = High or Critical

Then deadline of 24 hours from report time, escalating to Escalate to QA Manager at 75% of window

Notifies: Program Manager, QA / Compliance, Executive

When Incident type contains 'Medication'

Then deadline of 8 hours from report time, escalating to Nurse review required before closure

Notifies: Nurse / Clinical, QA / Compliance

When Service event status = completed

Then deadline of 24 hours from service end, escalating to Block billing eligibility after window

Notifies: DSP, Supervisor

When Required credential expires

Then deadline of 30 days before expiry, escalating to Remove scheduling eligibility on expiry

Notifies: HR / Training, Supervisor

When Shift requires medication administration

Then deadline of At assignment, escalating to Prevent assignment when credential expired

Notifies: Supervisor, HR / Training

When Service event marked ready to bill

Then deadline of At validation, escalating to Hold claim line until evidence chain complete

Notifies: Billing / Revenue, QA / Compliance

When Authorization utilization ≥ 90%

Then deadline of Daily evaluation, escalating to Notify Program Manager and Billing

Notifies: Billing / Revenue, Program Manager