Skip to main content

Compliance Score Override

Manually adjust AI-generated compliance scores with documented justification — including how to handle skipped sections and out-of-scope calls.

The Compliance Score Override feature allows authorized users to manually adjust an AI-generated compliance score on a specific call.

Use this when the score doesn't match your human review of the call. Reviewers can update the score, document the reason, and attach supporting transcript evidence.

With this feature, you can:

  • Override individual compliance metrics on scored calls

  • Add a required reason for every override

  • Highlight transcript evidence to support the change

  • Instantly update metric, category, and total call scores

  • Review override history, including reviewer name and timestamp

  • Revoke an override and restore the original AI score

Permissions

Override access is controlled by the Dialer Compliance permission.

To grant access:

  1. Go to Management > Platform Users

  2. Select the employee

  3. Open the General tab

  4. Locate the Dialer permissions panel

  5. On the Compliance row, select the correct permission level

Permission

What it allows

None

User cannot view compliance scores

Show

User can view compliance scores but cannot make changes

Edit

User can view, override, and revoke compliance scores

Note: Only users with Edit permission will see the Override action.

⚠️ If you don't see the Edit tab inside a category: double-check that your Dialer → Compliance permission is set to Edit (not Show) on your user profile. If it is and the tab still isn't visible, hard refresh the page (Ctrl + F5 / Cmd + Shift + R). If that doesn't resolve it, contact support — Compliance Score Override may not yet be enabled for your agency.

How to Override a Compliance Score

  1. Log in to the Dialer

  2. Go to Calls > Compliance

  3. Locate the call you want to review

  4. Scroll right to the Actions column

  5. Click the info icon to open call details

  6. Scroll to the Compliance Summary

  7. Find the metric you want to override

  8. Open the metric dropdown

  9. Click Edit to open the Override modal

Completing the Override

In the Override modal, complete the required fields:

Field

Description

Metric

The specific compliance question being scored

AI Score

The original AI-generated score

Override To

Select the new score: Pass or Fail

Reason

Required explanation for the override

Transcript Evidence

Highlight the supporting transcript text (optional in special cases — see below)

Once complete, click Save Override.

The metric score, category score, and total call score will update automatically.


Overriding When the Agent Skipped a Section

Sometimes the agent skips a required section entirely — there's no transcript text to highlight because the disclosure never happened. Here's how to override in that case:

  1. Open the metric for the skipped section.

  2. Set Override To = Fail.

  3. In the Reason field, write a clear explanation, for example: "Agent skipped this section. Required disclosure was not provided at any point in the call."

  4. For Transcript Evidence, you have two options:

    • Leave the highlight blank — the reason becomes the audit trail.

    • Highlight the adjacent statement where the disclosure should have been (e.g., where the agent transitioned away from the topic) to document the omission in context.

  5. Click Save Override.

📌 Tip: The Reason field is the most important part of an override without transcript evidence. Write it as if a CMS auditor will read it later.


When a Call Shouldn't Have Been Scored

Occasionally a call gets scored that isn't in scope for Medicare/ACA compliance review — for example, hospital indemnity, dental, ancillary product calls, retention calls, or disconnected calls that the AI processed anyway.

For these calls:

  1. Open each scored metric.

  2. Set Override To = Pass (so the call doesn't tank the agent's average).

  3. In the Reason field, write: "Not a Medicare/ACA call — out of scope for compliance scoring. [Call type: hospital indemnity / dental / ancillary / etc.]"

  4. Save the override.

📌 Long-term fix: If certain dispositions or queues are regularly producing out-of-scope scored calls, work with your CSM to exclude that queue or disposition from compliance scoring entirely.


My Call Has No Compliance Score Yet

If a call shows a yellow box, "Processing," or no score reasoning at all, here are the common causes:

  • Still being scored — Compliance scoring runs roughly hourly. Wait ~1 hour after the call completed, then refresh.

  • Call too short or no audio — Calls under a few seconds, or calls with missing audio, are skipped.

  • Scoring temporarily paused — During peak load or maintenance, scoring may queue up.

  • Out-of-scope call type — See above.

If a call still has no score after 1 hour, contact support with the call ID and we'll investigate.


How Overrides Appear

Overridden scores are clearly marked across the platform.

Indicator

What it means

Asterisk (*)

The score was manually overridden

Override Details

Shows the reason, transcript evidence, reviewer, and timestamp

Updated Totals

Metric, category, and total scores reflect the override

Revoking an Override

Users with Edit permission can revoke an override at any time.

To revoke an override:

  1. Open the call details

  2. Scroll to the Compliance Summary

  3. Locate the metric with an asterisk (*)

  4. Open the metric dropdown

  5. Click Revoke Override

This removes the manual adjustment and restores the original AI-generated score.

Best Practices

  • Write the reason clearly, as if it may be reviewed later by a CMS auditor

  • Highlight only the most relevant transcript evidence

  • Limit Edit permission to QA leads, supervisors, and compliance reviewers

  • Review override trends regularly to identify scoring drift

  • Revoke overrides that were applied by mistake

  • For repeated out-of-scope scoring, contact your CSM to adjust scoring scope — overriding is a short-term fix, not a permanent one

Important

Always include a clear reason when overriding a score. Transcript evidence is preferred but can be skipped for skipped-section overrides. This helps maintain an accurate audit trail and supports compliance review.

Did this answer your question?