"I need help!"
Free Space!
:)
7-year-old stuck a fork into an electrical outlet and it shocked them. Mom says the child appears fine, but just wants to make sure.
Yes.
Patient calls to schedule an initial FFA exam.
Transfer to Redwood Shores 650-853-6623
(Bonus - What WF and where do we find the information for the transfer.)
Filing order for a patient who carries 2 insurance policies by different employers.
WF - 74
Coordination of Benefits - Insurance that has been effective the longest is primary and should be filed first.
Regardless of age limitations/preferences, panel information, or any lapse in care, if the doctor is listed as the PCP in the chart you are okay to schedule. If patient has not been seen in 3 years or more, make sure that registration and insurance is up-to-date and accepted.
WF 50 - New Patient Registration Handoff
"I can't find the specialty department on the grid or find the specialist on the Sutter/PAMF website!"
Google the provider name followed by Sutter to find the result. (Example: Type in "David Tay, MD Sutter" in the search engine)
Established 48-year-old patient says they had chest pain yesterday morning after breakfast, then again when they got home from work. They took the day off to see if there is an appointment.
No.
A parent wants to make an appointment for their unborn baby in Mtn. View.
Transfer to newborn navigation: 408-523-3939
(Bonus - What WF do we use?)
Do not schedule, refer back to insurance.
WF 74 Verify Eligibility & WF 69 Medi-Cal County Plans - Medi-Cal and County Medi-Cal patients are considered established if they have been seen in Primary Care in the last 2 years.
WF 65 - Release of Information
Goal of calling the AL
Learn how to navigate resources and locate answers for current AND future calls.
Mother of established 15-year-old says patient was pegged in the eye with a baseball during his game today. He feels fine,but has a pretty bad headache. She just wants to see if there is an appointment with a provider today to check him out.
Yes.
A patient has a referral to see Margaret Lo, MD for a sports related shoulder injury.
Transfer to 650-853-2943
Self-Pay deposit amount for new patients.
$380 - WF 69 - Self Pay
Specify at the beginning of the message pt. declined an appointment and that patient stated they are able to wait for a response for the next business day.
WF 15 - Non-Stat Symptom Handling
"The Payor is down and I can't verify patient coverage!"
1. Quote self-pay and move forward.
2. Ask patient to have insurance call us to verify by phone.
3. Ask them to call back at a later time to verify coverage if they don't accept the self-pay policy.
Yes.
Unestablished, 40-year-old patient without a PCP assigned wants to establish care in Westside.
831-479-6601
We need to determine if the insurance for coverage MultiPlan under Cypress Benefit Administrators is active.
Call the insurance company to verify active coverage. We participate and the employer IS located in the PDF file as contracted.
Same Day Appointment Reminders:
• When scheduling a SDA, please make sure that the actual appointment is 30 minutes out from the time you schedule it. This will allow the patient to have ample travel time.
WF 31 & 32 - Find Appointment Same Day 18 and over (Under 18)
"The patient is late for their appointment, and it started 5 minutes ago. They still want to come!"
"Late" WF - Leave the appointment in Epic for the office to mark as No Show. Go to Find appointment with PCP and schedule a new appointment.
Established patients son says his 80-year-old father has been acting strange lately, saying funny things, and can't remember his relationship with his son just now. He is on his way to the ER with the patient.
No.
If the patient is on the way to the hospital or currently in the hospital advise patient to seek care at the facility. Document details of initial call from patient- verbatim or as detailed as possible using the most appropriate smart phrase. CLOSE TE and DO NOT ROUTE
PEDS patient has appointment in Burlingame for rash + blisters with fever and needs the contact number for appointment arrival.
650-652-8728
(Bonus - What WF do we find this information on?)
Patient asks if we are contracted with the Blue Cross Senior Advantage Care Plan.
No. PPL, line 122
Patient's requesting to schedule a routine mammogram are able to schedule with Radiology through a self-referral. Based on the following criteria..
WF 66 - Request for orders
Do this before calling the AL
Reference all necessary resources (WF's, clinic access pages, Payer Plan List, website, etc.)
No.
Patient wants to dispute a bill from Mills Peninsula Health Services, called the billing department and were told to contact their providers office.
Send staff message to: MP CALL CENTER 11386
WF used to verify HPSM.
WF 47 - Medi-Cal County Plans
Advise the caller that physicians and care centers do not take calls from pharmaceutical companies or other solicitors.
WF 35 - Forms and Misc Calls
"ID won't let me answer calls!"
Go into SI, provision ID, and retry. Inform leadership via chat or text for all SI issues.
Established 23-year-old patient was out at the beach all day yesterday and woke up with a painful sunburn with large, puss filled blisters on her neck, back and shoulders.
Yes
It's 6 p.m. PST and PEDS patient fell down staris and hit their head.
800-377-0151
The insurance company is not listed in One Source for verification, or it is through a third party, you may call the insurance company on the back of the card.
Yes - WF 74 - Verify Eligibility
Medicare Advantage: Patients are eligible once every calendar year for a Medicare Wellness Visit. There is no specific time requirement between wellness exams for Medicare HMO patients, as long as each exam occurs in a separate calendar year.
WF 48 - Medicare Wellness Visit