Specialist Referrals – When a patient is referred by PCP to specialist provider, the PCP needs to send a fax or electronic message to specialist with necessary referral note, specialist will then need to call and schedule the patient. Upon confirmation of appointment, notify PCP so PCP can submit a referral request to health plan. Once the actual appointment is complete, Specialist will need to send the consult note back to PCP.
Prior Authorization (PA) – When the specialist determines that the patient requires procedure in his facility or at any other facility, office needs to submit a PA request to health plan, review medical necessity criteria with plan and get the health plan approval. Use the approval to schedule the procedure for patient. FYI, we have recently automated ‘Get Authorization’
Looking for learn if anyone has already implemented an automated scheduling including patient self-service options, Patient Relationship Management tools if any or how you might have addressed.