Booking Rules/ Guidelines
Explain the booking guideline we follow when offering a date and time to the patient.
SAME DAY/ NEXT DAY- GREEN, YELLOW PINK SLOT TIMES
List out who are we liable to attend for limited relief of care:
NEW PTS ASSIGNED TO WD OR EXT PT WITH CHART #
Alexander is upset- his filling came out. He is mad because this is the 2nd time he has it done and it keeps falling off.
IRU
What is the difference between a PPO plan and a DHMO plan?
FREEDOM OF CHOICE FOR PPO- DHMO ARE ASSIGNED
When navigating, how can we distinguish a General office from an Orthodontic office?
OFFICE NUMBER FOR GENERAL= W AND FOR ORTHO= R
Shelly is calling in to get a general checkup; she was at our office back in January 2017. Under what database would Shelly be booked?
NPR
List out the pain qualifiers for ER care:
TRAUMA, SWELLING, INFECTION, PAIN 6 ABOVE AND/ OR BLEEDING
Kimberly calls in frustrated that the website is not allowing her to make the payment, she is upset she may be charged a late fee.
COLLECTION
What should we do if a DHMO patient wants to be seen at another office?
RECOMMEND TO CALL INSURANCE PROVIDER SO OFFICE CAN CHANGE
When determining if I can book an existing patient in, what piece of information should I look at and where can I find it in the CCA?
LAST ENCOUNTER- WDOS BOX (BOX #3)
Amber is calling for a general checkup; she came to the office to do a filling back on June 13th 2021. Can you book Amber in?
Is a fallen bracket considered an emergency for Orthodontics?
Shane called angry that he was booked at the wrong office and had to drive a whole hour to get there for him not to be seen.
BOOK THE PT IN CORRECTLY
If the patient does not have their Medi-cal card or Insurance card number- what can we substitute it with to do an eligibility check?
SSN
When entering a patient insurance name, where would I document this information?
BOOK APPT CARRIER SEARCH
Dylan is calling because he wants to get a root canal; he was at the office on January 10th of this year. You notice that he has a campaign code TNC with a false workable status. What should we do?
SEND/ Transfer TO THE OFFICE
Roxanna is calling in with discomfort on her tooth; her level of pain is a 4. However she insists she wants to be seen or speak to the doctor. What can we do?
TRANSFER TO OFFICE
Mathew calls in upset that office staff made him wait for an 1 hour to be seen and they made some racist comments towards him,
Customer Service
List out the necessary information we need to gather from an insurance payer
INSURANCE NAME/TYPE, MEMBER ID NUMBER/SSN, MAIN HOLDER NAME
If a caller wants to book a family member under the same office, what option in the Call Center Appointment (box4) would you choose?
BOOK FAM MEM
Yesenia calls in to inquire if our Orthodontist can check her braces she got in Mexico. What should be the process we follow?
BOOK: SET EXPECTATION (RELEASE FORM), INFORM SCREENING WILL BE DONE FIRST AND ORTHODONTIST WILL FOLLOW UP ON THE NEXT STEP
List out the steps we take when a patient does qualify as an Emergency Care case:
Attempt to book same/next day, Call the office, Book PO check, Call ER line, Send email to managers.
Kate calls in demanding to speak to a supervisor and refuses to give you any type of information; unfortunately your supervisors are in a meeting
INFORM AND OFFER CALL BACK.
If a patient mentions he has CHIP has dental coverage- what should be the follow up question?
IS THIS THRU THE STATE OR EMPLOYER
Explain what would be the process we take when patients’ number does not populate any information but insists they have not changed phone.
1ST ASK FOR PHONE NUMBER ON FILE- 2ND IF 1ST STEP FAILS- ASK FOR ZIP CODE AND OFFICE TO SEARCH IN EAB. 3rd user Full name and DOB to search in DCMS.