Referral Entry
In the RFL Team Information tab, the contact type of DSM is used when entering this type of referral.
What is IMQ?
This category of insurance plan does not require authorization.
What is PPO?
A patient living in the Sacramento area is in this foundation footprint.
What is Sutter Medical Foundation (SMF).
This system allows us to make and receive calls, but remember that all calls are recorded for Quality and Assurance purposes.
What is Interaction Desktop?
This Teams Channel allows us to see a variety of resources including Workflows and Contracted payor lists.
What is Knowledge Management?
When entering a referral from fax, this General Tab class should be used.
What is Outgoing?
This type of insurance may require an authorization if patient is assigned to a primary care provider (PCP).
What is a POS?
A patient living in San Francisco lives in this Sutter region.
What is the Bay?
This alternate insurance verification site can be used if unable to verify through Epic, or if needing additional information such as medical group. (Don't worry if access takes a little longer)
What is One Source?
This resource can help you determine if Sutter accepts a patient's insurance, but remember that you must select the proper one for the patient's region.
What is the Contracted Payor's List (CPL)?
When a patient calls to request a specialty referral, this workflow is the place to go.
What is Self Made Referral - Patient?
When entering a referral where the patient has a managed Medi-Cal plan, you will use this as the Open status in the RFL Team Info tab.
What is Open HMO?
Sutter Medical Foundation (SMF) and Sutter Gould Medical Foundation (SGMF) are the two foundations found in this region.
What is the valley?
Within Epic, this is the department to use when logging in.
What is 59 (Sutter Specialty Network)?
This resource allows us to check how soon a patient might be able to be seen within a department.
What is the Capacity Dashboard?
By entering this scheduling status into the Scheduling tab during referral entry, the referral processing time is on hold (especially important for Medicare).
What is pending?
Once a Sutter HMO referral has been sent for authorization to Utilization Management (UM), only these two tabs can be updated within the referral. Any other updates would require that we contact UM to request updates be made.
These three Sutter Foundations make up the Bay region.
What are Sutter Pacific Medical Foundation (SPMF), Sutter East Bay Medical Foundation (SEBMF), and Palo Alto Medical Foundation (PAMF)?
When entering a correction in the Kronos timekeeping system, you must always use this format to specify the time.
What is military time?
This resource provides guidance on referral note types, open and closed statuses, and each SSN smart phrase along with when and how to use them.
What is the Referral Dictionary?
These two locations can be used to see if patient is active on My Health Online (MHO) to send notifications: One to see if patient has signed in on their own behalf, and the other if a proxy has logged in.
What are the referral sidebar, and in the patient chart (top left corner)?
Managed care plans (HMOs and Managed Medi-Cal) require that referrals come from this provider.
What is the primary care provider?
A patient living in Burlingame, CA lives within this Sutter Foundation footprint.
What is Palo Alto Medical Foundation (PAMF)?
It is important to know how to navigate to the appropriate place to report system issues. This icon AND this phone number can be used to submit a report and request assistance.
What are the "Help" icon, and 888-888-6044?
This website resource contains several books with different types of information: departments and pools, important phone numbers, as well as specialty information for Behavioral Health and Gender Care referrals.
What is Answer Book?