Referrals
Providers utilize this priority status when a referral requires processing within 24-48hrs.
STAT and/or Urgent
Referrals that warrant eligibility checks on the insurance.
Any referral with insurance.
The specialty facility that CHA is contracted with for PCF coverage.
Reno Diagnostic Center
Imaging orders that do not require any supporting documentation to be processed.
X-rays
(+100 if Screening Mammos are mentioned)
Jordan Williams
Attachments that should be included with each referral.
Patient ID, insurance cards, supporting medical records, imaging (if applicable), & labs (if applicable)
Four health plans that require RadMD authorizations for advanced imaging.
Silversummit, Ambetter, Allwell/Wellcare, & Molina
Imaging services that qualify for PCF coverage.
X-rays & Ultrasounds
Four healthcare facilities that offer imaging services. (+100 points if you can name the specialty clinic offering imaging services)
Reno Diagnostic Center, SMMG, NNMC, & Renown (+ Sierra Cardiac Imaging/Challapalli Cardiology)
The provider overseeing our complex patients & recently discharged patients.
Dr. Tartakoff
5 specialties that don't normally require authorizations from the PCP.
Physical Therapy, DME, Home Health, Hospice Care, & Palliative Care
Health plans that are no longer contracted with CHA for primary care services as of this summer. Be specific!
Hometown Health HMO & Senior Care Plus
Staff that must be included on PCF emails.
Jenn Wheeler & Daisy
Imaging services that require submission on RadMD prior to processing.
Specific to Silversummit & Molina patients:
Direct extensions for BH, Dental, & MA Triage. (+100 for the direct extension & phone number for Care Coordination)
BH - 127
Dental - 167
MA Triage - 7280 Eng (+100 for the Spanish extension, 7281)
Care Coordination - 5906, 775-324-0926
The queues that pregnancy referrals, BH referrals, & dental referrals are reassigned to. (+100 if you can name the POC for each department)
CHA PREGNANCY, BUCKET - Alondra Mora-Ayala
BH Assistants, BUCKET - Abril Arguello or Keala Wallace
CHA DENTAL, Bucket - Blanca Avila-Falcon
The Silversummit plan that requires in-network referral authorizations.
Ambetter Battle Born
Places where Care Coordination can find PCF related documents. (+200 points if you can show us how to access them)
SharePoint & P Drive
Diagnostic exam that is often mistakenly submitted as an imaging order by the PCPs. (HINT: They are performed internally.)
EKG
CHA Medical Directors overseeing providers at all 6 clinics. (HINT: There's only 3.)
Dr. Popko, Dr. Fernandez, & Dr. Lopez
Workflow for referrals (& imaging) for patients who have or intend on getting AHN.
1. Call patient the day that the referral is created to ensure a physical copy of the referral was provided by their MA & that they know to take that to AHN to be referred.
2. 10 days later, call again to determine status. If patient has followed through, the referral can be sent directly to specialist selected by AHN. If the patient has not, the referral will be processed as self-pay. Patients can call later to have it rerouted if necessary.
3. Provide patient with the specialist contact info & move to pending.
Single Case Agreement or Letter of Agreement
The process for submitting & processing a PCF order.
1. Confirm that patient & order qualify for PCF - Must be an XR or ultrasound & the patient cannot have an outstanding balance with CHA.
2. Complete PCF Request Form & email to Jenn wheeler with Daisy cc'd for review.
3. Once approved, *BILL TO CHA* is noted in the order notes & a PCF PA form is completed through the letter templates on ECW.
4. The imaging order, the PCF PA form, & the OV notes (if applicable) will be faxed as one document through the "Medical Records" option in the patient hub. *BILL TO CHA* is also noted in the subject line.
5. An action can be created & the imaging order can be moved to Rad Pending.
The workflow for imaging results received from a non-CHA provider for an inactive patient. (+100 point if you can name our POC for QI matters)
1. Contact the imaging clinic to notify them that the results were sent to the wrong facility.
2. Submit a report on Healthcare Safetyzone.
3. Reassign the imaging order to Rad Pending.
BONUS: Andrea Mejia
One provider from each clinic. (3 chances but +200 points if you can do it on the first try!)
Wells, CCC, NR, NV, SV, Sparks