The importing window automatically flags items being imported by non-provider users as requiring a sign-off. You won't see this when importing under your own account, as Amazing Charts assumes if you are the one importing, you know what you are importing.
When one of your staff imports an item other than a "non-medical" item (such as an insurance form), it will appear in your inbox and require you to sign off the item.
While this sounds good in practice, I have heard from a number of users how clunky the sign-off process can be. V4 (beta release this week?) addresses this with a process that should reduce the number of clicks to sign-off dramatically by opening each item directly and allowing comments, messaging to staff, and signing off on that same window.
