Overview
An Addendum allows users to make changes to a resolved careflow after it has already been completed and locked. This is used when corrections or additional information need to be added to a patient's chart after the documentation has already been finalized.
Once an addendum is started, users can update documentation and re-save the careflow while maintaining a record that changes were made after the original completion.
Key Points About Addendums
Addendums can only be created on resolved careflows.
The user who originally resolved the careflow must create the addendum.
If another user needs to make the update, the careflow can be assigned to them.
Changes made during an addendum are labeled “Updated by [User Name]” in the chart.
The system records when the addendum was applied in the Session Log.
If configured, updated notes are automatically sent to PCC when the addendum is saved and locked.
How to Access a Resolved Careflow
The fastest way to access a careflow for an addendum is through the patient record.
From the Patient Record (Recommended)
Navigate to the Patient List.
Search for and open the patient record.
Click Careflows.
Use the Filter and select Resolved.
Locate the careflow you want to modify.
Click View.
Starting an Addendum
Once inside the resolved careflow, you will see two options:
Start Addendum
Assign
Start Addendum
Select this option if you are the user who resolved the careflow and will be making the update.
Assign
If the user who resolved the careflow is not making the update, select Assign and choose another user from the dropdown list. The addendum will then appear in their careflow list for completion.
Editing the Careflow
After clicking Start Addendum, the screen will indicate that the Addendum is in Progress.
You can now navigate through the careflow steps just like during the original workflow.
Users can update items such as:
Billing codes
Billing conditions
Visit documentation
Clinical notes
Any other fields included in the careflow
Example Update
Navigate to the Chart section.
Select the appropriate form (for example, Initial Patient Visit).
Update the necessary information.
If a field is modified, the system will display:
“Updated by [User Name]”
This indicator confirms that the information was edited during the addendum process.
Navigating the Careflow During an Addendum
After making updates:
Continue navigating through the careflow pages.
Click Next to move forward.
Skip any pages that do not require updates.
Navigate to the Provider Sign-Off step.
Saving the Addendum
Once all updates are complete:
Click Save Addendum.
Select Save and Lock.
A confirmation page will appear indicating that the addendum has been applied.
Confirmation Message
“Addendum Applied”
This confirms that the update has been successfully saved.
New Enhancements
Time Tracking and Adjustments
The Careflow timer now reflects the cumulative time across all sessions associated with a careflow.
When an addendum reduces previously recorded time, the timer will display in red to clearly indicate a negative adjustment.
Automatic Billing Threshold Checks
The system automatically evaluates billing thresholds when an addendum changes the recorded time.
For example, if a time adjustment causes a careflow to fall below the minimum time required for a billing code (e.g., under 20 minutes), the system will automatically strike out the code since it no longer qualifies.
This ensures submitted billing information remains aligned with finalized careflow details.
Billing Adjustments and Strikeouts
When an addendum changes a bill that has already been submitted, the system generates a strikeout to reflect the adjustment.
A notification banner appears across all tabs of the Bills page when there are pending strikeouts requiring review, ensuring billing teams are aware of changes.
Accessory Code Support
Accessory billing codes (secondary codes linked to a primary service) are now supported directly within the platform.
These codes are stored in the database and displayed as dedicated sub-rows on the patient page, providing greater visibility into all codes associated with each service.
New “Void” Status
A new Void status is now available for submitted careflows.
This status clearly indicates when a finalized bill has been nullified.
It supports more accurate tracking and auditing of submitted records.
Where Addendums Appear in the System
After saving the addendum, it will be reflected in several locations.
Session Log
The Session Log will display an entry showing that an addendum was applied along with the date.
Example:
Addendum applied – [Date]
Careflow Sessions
Within the patient record:
Patient Record → Careflow → Sessions
You will see a session entry reflecting the addendum date.
Updated Session Date
The Last Session Date updates to reflect when the addendum was applied.
PCC Integration
For facilities connected to PCC, the updated documentation is automatically sent when the addendum is saved and locked.
The note sent to PCC will include text indicating that an Addendum was applied to the documentation.
Best Practices
Create an addendum only when documentation changes are necessary.
Ensure the correct careflow is selected before starting the addendum.
Verify all updates before selecting Save and Lock.
Assign the addendum to the appropriate user if they originally resolved the careflow
Review time adjustments, billing strikeouts, accessory codes, and void statuses carefully to ensure compliance and accuracy.