Many Health Systems face a challenge in managing referrals and scheduling resulting in referral leakage, loss of usable capacity and extremely long appointment wait time. Referral leakage results in not only a significant loss in annual revenue but affects quality metrics due to patient dissatisfaction and delay in care. This can also lead to loss of usable capacity and sometimes high no-show rates.
One part of the solution to this challenge is to set up an effective and easy to use Referral Management system with a centralized referral hub and triage model. A hub will collect referrals from external as well as internal sources and a referral triage model will ensure fast allocation of the referral to the provider. Creating a referral hub requires enabling external physicians with physician referral portals, integrations with Fax, integration with EMRs and other data sources. Triaging will run physician search effectively with insurance verification and physician first availability. This will result not only in improving patient satisfaction but will also lead to better care as patients will be at providers desk much quicker.
This application comprises a physician portal built on the Appian platform which allows physicians to create a referral online with relevant medical records. Referral coordinators can then work on these referrals and onboard the patients based on defined workflows. Referring doctors, not into the system would generally send faxes to the desired care networks. These faxes can get missed resulting in ignorance of urgent cases that were referred. Our solution handles such faxes as emails. The attachments are processed to extract meaningful information about the patient to create a referral case. For any missing information, the referrer is emailed with details of what information is missing. The request is assigned to a specialist. They will enter the suitable appointment time and submit thier task that triggers emails to inform the patient and referrer. In case of rejection, this request is assigned to schedulers who can select the appropriate specialist based on their existing appointments.
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