The platform
One evidence chain for the whole agency.
Healthcare operations should not be a collection of disconnected systems. Paloma connects clinical care, administration, workforce, revenue and compliance around the same operational truth, so every order, visit, clinician, authorization, document and claim belongs to one chain of evidence.
The engines
Six views of one event.
Each engine owns one view of the agency’s work and reads the others. None keeps a private copy, which is why a question asked in one place gets the same answer in every other.
Clinical
Referral, patient, assessment, order, plan of care, encounter, documentation and clinical review. A shared encounter core, with documentation that belongs to the service line and the discipline.
Administration
Intake, scheduling, communications, documents, customer and physician relationships, supplies, exceptions, reporting and management. The agency itself, not only its charts.
Revenue Cycle
Authorized service, billable event, coding, validation, invoice or claim, submission, acknowledgment, adjudication, payment and reconciliation. One billing record that every form reads.
From referral to revenue →Continuous Compliance
Regulation and standard, agency policy, operational obligation, workflow control, evidence, exception, corrective action and audit trail. The engine that watches the other five.
Continuous compliance →Workforce
Demand from authorized care, the agency’s own staff, credentials, readiness and availability, and Paloma Talent when the roster cannot cover.
Clinical demand meets workforce supply →Interoperability
Paloma as the operating layer, with payroll, screening, license sources, clearinghouses, pharmacy systems, laboratories and accounting connected to it.
Interoperability →One visit, six views
What each engine records about the same hour of care.
- ClinicalThe order that governed, what was done, the note and its review
- AdministrationWhen it was scheduled, changed, confirmed and completed
- Revenue CycleThe authorization it used, the billing rule and what it is worth
One visitRecorded once, by the person who knows it
- Continuous ComplianceThe obligations it satisfied and the ones it left open
- WorkforceWho went, and their license and competencies on that date
- InteroperabilityWhat was sent out or brought in because of it
| Engine | What it knows about this visit | What it needs from the others |
|---|---|---|
| Clinical | Which order governed, what was assessed and done, what the note says, who reviewed it | That the clinician was eligible (Workforce) and the visit was authorized (Revenue Cycle) |
| Administration | When it was scheduled, changed, confirmed and completed; what was communicated to whom | The order’s frequency (Clinical) and the clinician’s availability (Workforce) |
| Revenue Cycle | Which authorization line it consumed, which billing rule applies, what it is worth, where the bill goes | A reviewed note (Clinical) and the facts of the visit: duration, mileage, discipline, date |
| Continuous Compliance | Which obligations the visit satisfied, which it left open, and who owns each open item | Evidence from every other engine. It owns the requirements, obligations, exceptions and corrective actions that evaluate that evidence |
| Workforce | Who went, with what license, verification and competencies on that date; what the visit pays the clinician | The requirement the patient creates (Clinical) and the schedule (Administration) |
| Interoperability | What was sent out or brought in because of the visit: a note to a pharmacy, a claim to a clearinghouse, hours to payroll | The canonical record to send, so no second copy is created outside |
The chain a system has to keep intact
- Referral
- Clinical authority
- Authorization
- Workforce requirement
- Assignment
- Encounter
- Documentation and review
- Billable service
- Claim or invoice
- Payment
- Reconciliation
An agency’s problems are almost always a broken link in this chain. Care was given without a signed order. A visit was made outside its authorization. A clinician was assigned whose credential had lapsed. A note was approved that the payer’s rule does not accept. A claim was sent for a service the record cannot support. In separate systems each of these is discovered late, by the person downstream.
In one record they are discovered where they happen. The scheduler sees that the authorization has no visits left. The reviewer sees that the note is missing what this payer requires. The biller sees why a visit cannot be billed and exactly which fact is missing.
Four facts that are usually treated as one
Most agency software was shaped by one payer and assumes that payer’s arrangement everywhere. Real work does not behave that way. Who is clinically ordering the care, who has authorized it, who will pay and under what terms, and what was actually delivered are four facts that often arrive in four documents on four different days.
| Fact | What it is | Where it comes from |
|---|---|---|
| Clinical authority | What care is ordered: the practitioner, diagnoses, disciplines, orders, frequency, certification period | A physician’s order, a plan of care, a payer’s clinical note |
| Service authorization | What a payer approved: lines by discipline, each with dates, a quantity in its own unit and a frequency | A payer’s approval; for a pharmacy under contract, the order itself is the authority |
| Billing authority | Who pays and on what terms: a contract, a payment authorization or a fee schedule, with dated pricing rules | A signed agreement, a rate sheet, a payer program |
| Delivered care | What happened: the encounters, by whom, for how long, with what documentation | The visit itself |
Keeping them apart is what lets one platform serve very different arrangements without being rebuilt. A specialty pharmacy pays a nursing agency a flat amount for the first hours of a visit and an hourly rate after, with mileage. A government program approves a number of visits per discipline at a rate per visit, in a document that arrives after the clinical approval. An episodic payer pays for a period of care while still requiring every visit on the claim. A family pays an hourly rate for shifts. Each is the same structure with different contents.
It also keeps three numbers honest that are easily confused: the care that was delivered, the units reported on a claim, and the basis on which it is paid. One visit can be one clinical encounter, several fifteen-minute units on a claim line, and part of a payment made for a whole period.
What is common, and what is specific
A new service line brings its own documentation, payment rule and regulator. It reuses the patient, the order, the schedule, the workforce, the evidence and the billing record. The service lines and the payer and program models are described separately because they are two different axes: what care is delivered, and who pays for it under what rules. Why the first service line was home infusion is set out in the True North.
Operating experience, translated into architecture
Paloma models the distinctions operators know matter.
Each of these was learned by running agencies, and each is a place where software that blurs the two produces a denied claim, a survey finding or a risk to a patient.
| This | Is not this | Why it matters |
|---|---|---|
| An order | An authorization | A physician can order care a payer has not approved, and a payer can approve care no one has ordered. |
| An authorization | Payment authority | Clinical approval and the document that permits billing can arrive separately, days apart. |
| A visit | A billing unit | One encounter may be reported in fifteen-minute units and paid as part of an episode. |
| A credential on file | Primary-source verification | A copy shows what someone handed in. Verification is a check with the source, with a date and a result. |
| A medication reported stopped | A discontinuation order | What a patient says and what a prescriber ordered are different facts with different authority. |
| A course of therapy | Today’s dose | A three-day order for a total amount is three administrations. The nurse documents one of them. |
| A page in the same fax | Evidence about the same patient | Identity is established for the evidence itself, never assumed from how it arrived. |
| A completed task | Sufficient evidence | Work can be done well and still leave no record a surveyor or payer will accept. |
Clinical intelligence
A course of therapy and today’s administration are different facts. Paloma’s architecture is designed to represent the regimen, the administration due on a given day and any true variance separately.
Workforce intelligence
A nurse can be ready for patient care while the personnel file still has historical gaps. The platform separates what affects assignment, what the agency must act on, and what is only missing history.
Revenue intelligence
A payer may authorize visits, require claims in fifteen-minute units and pay by episode. Care delivered, units reported and payment basis are held as three facts.
Compliance intelligence
A survey requirement does not stay a paragraph in a manual. It becomes a traceable obligation with evidence, an owner, a due date and its exceptions.
Commitments
Rules the architecture does not bend.
Every fact is recorded once
A billing fact, a credential, an order: defined in one place and read everywhere. A second copy is how two screens come to disagree.
Nothing is invented
A value the system does not hold is shown as a gap with its source named. No default stands in for a fact on a form, a claim or a report.
Nothing silently falls back
When a rate, an authorization or a payer rule is not established, the work stops there and says so. It never borrows another payer, another patient or an old rate.
Evidence is graded
Reported, documented, extracted and verified are different states with different names. Verified is the result of a recorded check, never a field someone fills in.
Rules are dated data
Regulations, standards, rates and code sets carry effective dates and sources, so a change in the rule is a change in data and history is judged by the rule in force at the time.
A person, a job and a login are three things
An agency can hold a clinician on its roster, credential them and schedule them before they ever sign in, and keep the record after access ends.
Documentation follows the service
The visit is common. What must be written depends on the service line and the discipline, so a therapist is never handed a nursing note.
Access control lives in the data layer
What a person may see or change is enforced where the data is kept, for every agency separately, and not only on the screen.
What the architecture is for
An intact evidence chain has a use beyond tidy records. It is what makes it possible to examine the agency continuously against everything it is held to: federal conditions, state rules, accreditation standards, payer terms and its own policies. A system that only records operations can tell you what happened. One that holds the whole chain can tell you what is missing, where the agency is exposed, and who should act, before a surveyor, a payer or an auditor asks.
That is the difference between software that stores an agency’s work and software that understands and governs it. It is described in full under continuous compliance.
Paloma Cares
See it in Paloma Cares
See the six engines at work in Paloma Cares. It shows what the product does, with its published price and a working demonstration agency.
From Paloma Cares
What Paloma Cares supports today
This list is published by Paloma Cares and was last verified on 2026-10-10. palomacares.com is the source for what the product does now.
- Referral intake with AI document readingLiveSee it in Paloma Cares →
- Orders and the governing orderLiveSee it in Paloma Cares →
- Scheduling with staff readinessLiveSee it in Paloma Cares →
- Clinical review before billingLiveSee it in Paloma Cares →
- Pharmacy invoices, statements and paymentsLiveSee it in Paloma Cares →
- Obligation ledger and survey toolsIn progressSee it in Paloma Cares →Obligation ledger, owned open items, survey binder and survey rehearsal are being strengthened.
- Find Staff from the patient chartLiveSee it in Paloma Cares →The staffing need is worked out when Find Staff is opened from a chart, referral or visit.
- Native integrations (document reading, email, provider registry, Talent)LiveSee it in Paloma Cares →
Questions
The platform: common questions
What are the six engines of the Paloma platform?
Clinical, administration, revenue cycle, continuous compliance, workforce and interoperability. They are not separate products. Each owns one view of the agency’s work and reads the others, so a patient, an order, a clinician, a visit and a claim are each recorded once.
What is an evidence chain?
The connected record of why a piece of care was delivered, by whom, under what authority, with what result, and what it earned: referral, order, authorization, assignment, visit, documentation, review, billing and payment. In one system the chain is intact, so any link can be traced forward or back.
Why not connect separate best-of-breed systems?
Because the agency’s staff then become the integration, re-keying and reconciling copies of the same visit, and nobody can see the whole chain. Specialized services such as payroll, a clearinghouse or a screening vendor still connect to the operating record. They do not replace it.
How can one platform serve infusion, home health, hospice and private duty?
By separating what is common from what is specific. The patient, the order, the schedule, the workforce, the evidence and the billing record are common. Documentation, payment rules and regulators differ by service line and payer, so those are held as dated rules and service-line content instead of being built into the core.
What does it mean that the payer is not assumed?
Who pays, what was authorized, how it is billed and what was delivered are four separate facts that may come from four different documents. The platform holds them apart: a counterparty, an authorization with service lines, a billing authority with pricing rules, and the delivered encounter. A pharmacy under contract, Medicare, a Medicaid plan, a VA network and a private-pay family all fit the same structure.
Where does Paloma Talent fit?
Authorized care is workforce demand. A patient’s location, discipline, competencies and dates define a requirement that is searched against the agency’s own staff first. Paloma Talent supplies clinicians when the agency’s roster cannot, and it is also useful on its own to any healthcare organization.
The products
The software doing it.
Use either independently. Use them together when you want patient demand and workforce supply to work from the same context.