RefTrak for ACMC User Guides Thursday, July 13, 2017 Please email your questions and comments to [email protected] To get a copy of this document please go to http://carcu.acmedctr.org and click on the RefTrak Use Guides. You can also get a RefTrak Tutorial booklet and other related documents there. 1 OVERVIEW ...................................................................................................................... 4 HOW DOES IT WORK? ................................................................................................. 4 WILL I BE NOTIFIED WHEN AN APPOINTMENT IS SCHEDULED? .......................................... 5 WILL I BE NOTIFIED OF THE REFERRALS AWAITING MY ACTIONS? .................................... 5 WHAT ARE QUEUES? ....................................................................................................... 6 QUEUES BASED ON “STATUS GROUP” ............................................................................. 6 “Awaiting PCP Action” .............................................................................................. 6 “Awaiting Scheduling Office Action” ......................................................................... 6 QUEUES BASED ON “REFER TO” CLINIC OR GROUPS OF CLINICS..................................... 7 QUEUES BASED ON “SUBMIT DATE” ............................................................................... 7 QUEUES BASED ON “APPOINTMENT DATE” .................................................................... 7 QUEUES BASED ON “ACTIVITY DATE” ........................................................................... 7 CAN I “ACT” ON THE REFERRALS AND APPOINTMENTS? ................................................... 7 HOW DO I ? ...................................................................................................................... 8 … become a user ......................................................................................................... 8 ... check on the status of my referral? ......................................................................... 8 ... contact CARCU? ..................................................................................................... 9 … find a referral? ....................................................................................................... 9 … log on? .................................................................................................................... 9 … get to the Consultation Form?................................................................................ 9 ... print a screen? ........................................................................................................ 9 ... respond to CARCU requests for confirmation, changes, etc.? ............................. 10 ... submit a referral? ................................................................................................. 10 WHAT IS? ....................................................................................................................... 11 …Action..................................................................................................................... 11 …Action Agent .......................................................................................................... 11 …Action History........................................................................................................ 11 …Appointment Call List and Letter .......................................................................... 11 …Attachment ............................................................................................................. 12 …Appointment Status ................................................................................................ 12 …Consultation Form ................................................................................................ 12 …Follow-Up Appointment – Pending Authorization ................................................ 12 …Request Patient Call Back to Schedule Appointment ............................................ 12 …Refer From Unit .................................................................................................... 13 …Referral Status ....................................................................................................... 13 …Refer To Specialty ................................................................................................. 13 …Refer To ................................................................................................................. 13 …Status ..................................................................................................................... 13 …Status Group .......................................................................................................... 14 …Submit Referral Wizard ......................................................................................... 14 …Tracking Number ................................................................................................... 14 …Work Flow Diagram .............................................................................................. 14 2 REPORTS ........................................................................................................................ 15 CODE TABLES .............................................................................................................. 15 Sample of Status Group Table .................................................................................. 15 Sample of Action Table ............................................................................................. 17 Sample of Status Table .............................................................................................. 18 3 Overview RefTrak is a web-based application, used to track referrals from Primary Care Providers to Specialty Clinics and from Specialty Clinics to each other. Since it is web-based, the application can be accessed by authorized users from anywhere with connection to the Internet. RefTrak System’s Features include Electronic submission of referrals. Tracking of referrals from the submission time to the completion of appointment(s) and progress notes. Online inquiry of referral status and appointment status. Display specialty clinic’s guidelines and require the referring clinic to acknowledge that the referral complies with guideline. If not complied, the referring clinic is required to explain why not. Facility for the organization administrator to post up to date news and announcements. Statistical Analysis made possible by reporting on statuses and data collected over time such as: Time Out to Appointment, Referrals to Specialty Clinics per Referring Source. How does it work? Here’s a simple cycle of a referral going through RefTrak. Step1: The referring clinic submits a referral to a specialty clinic. Step 2: The specialty clinic reviews and approves the referrals. Step 3: The specialty clinic schedules an appointment. Step 4: The referring clinic confirms the appointment. Step 5: The specialty clinic records if the patient showed up for the appointment Step 6: The specialty clinic records that the progress notes are sent. Step 7:The referring clinic acknowledges that progress notes are received. Step 8: After 60 days of in-activities passed the last appointment, a program run at CARCU will turn the referral status to “closed”. RefTrak’s actions are driven by the user’s role. If the user is from a referring clinic, only a number of actions are available to her. For example, the referring clinic user can submit a referral but she can not schedule her own appointment. However, if the logged in user is from the specialty clinic such as Eastmont or from CARCU (Central Appointment Referral Coordination Unit), she can approve, reject, schedule etc. 4 Whenever an action is executed, the action is recorded in the action history along with who did it, when was it done, and an audit trail of any fields changed. In addition, the the referral status and the appointment status are moved forward to the next stage in the work flow by the system as appropriate. Will I be notified when an appointment is scheduled? You will not be notified by email or fax but you can find out which referrals were scheduled. When CARCU schedules an appointment, the referral’s status is set to ‘scheduled’. The appointment is added to the system and its status is set to ‘scheduled’. When you go to the Referral and Appointment Queues screen and click on the status group drop down list box, one of the choices to select is “UnConfirmed Appointments”. By selecting this status group, then click Search, the system will return to you a list of scheduled appointments, not yet confirmed by the referring clinic, and those appointments which the referring clinic requested a reschedule but CARCU has not responded with a new date. Will I be notified of the referrals awaiting my actions? You will not be notified by email or fax but you can find out which referrals need your attention. The Referral and Appointment Queues screen is where you can search for lists of referrals and appointments meeting one or more criteria. The system will return a list of referrals meeting the criteria you specified. In the sample screen below, the user is asking the system to select all referrals referred by “Asian Health Services” to “All” specialty clinics, at all “Urgency” levels and that these referrals have an appointment scheduled for “Tomorrow”. 5 What are Queues? Queues are lists of referrals and appointments selected based on one or criteria. Queues are requested from the Referral and Appointment Queues screen. Queues Based on “Status Group” Since each referral has a current status, it is possible to group them together in a status group. The status groups are table driven and are preconfigured by your RefTrak administrator. Your RefTrak administrator can show you the up to date definition of the status groups online. A sample of the Status Group table is at the end of this document. Here are some examples of queues based on status group: “Awaiting PCP Action” When asking the system to give you the “Awaiting PCP Action” status group, you will get a list of referrals requiring the primary care provider to act on. Included in this status group may be referrals waiting for an acknowledgment that an appointment was scheduled and the PCP needs to confirm it, or a referral was conditionally approved but further documents are still required, or progress notes have been sent and the provider need to acknowledge that the notes were received. “Awaiting Scheduling Office Action” When asking the system to give you the “Awaiting Scheduling Office Action” status group, you will get a list of referrals requiring the Scheduling Office to act on. Included in this status group may be referrals submitted but have not been approved, referrals approved but have not been 6 scheduled for an appointment, or referrals with a request for a change of appointment date and time. Queues Based on “Refer To” Clinic or Groups of Clinics By selecting a Refer to clinic – such as Cardiology – you can get a list of patients referred to that clinic. This queue is often used by CARCU to quickly get a list of referrals assigned to a particular coordinator based on a group of specialty clinics. Queues Based on “Submit Date” By specifying a date range or a particular date in the submit date box, you can get a list of referrals submitted to the specialty clinics. Queues Based on “Appointment Date” By specifying a date range or a particular date in the appointment date box, you can get a list of appointments scheduled for “tomorrow”, “this week”, “next week” etc. or appointments scheduled for a date range you specified. Queues Based on “Activity Date” By specifying a date range or a particular date in the activity date box, you can get a list of referrals and appointments which were “touched” during that date range. By setting it to “today”, you will include in your search referrals “touched” today by someone, or by the system today. Can I “act” on the referrals and appointments? You can ‘act’ on the referrals and appointments via the Referral Action screen. Once you have located a referral by finding it on the Find Referrals and Appointments screen, or the Referral and Appointment Queues screen, click the “Select” button to next to the tracking number of the referral you are interested in. This will bring you to the Referral Action screen. 7 If the referral has appointment(s), all appointments will be listed, followed by the Action box. By clicking on the Action drop down box, you will see a list of actions you can take on this referral and actions you can take on the highlighted appointment. Only appropriate actions are listed based on the appointment you select. For example, if the appointment you selected is “Unconfirmed”, the Action box will list “Confirm Appointment”, “Change/Reschedule Appointment” etc. You can select one of these actions, optionally enter a comment in the History Notes box, then press the OK button. How do I ? … become a user 1. ACMC requires that you fill out a User Authorization form and submit it to IS department. 2. An IS staff will enter your email as your user id, ‘reftrak’ will be your default password which you are required to change when you log on the first time. ... check on the status of my referral? 1. Click on the Refer(PCP) tab. 2. If you know the referral’s tracking number, the patient name, the medical record number, or the social security number, click on Find Referrals. This will take you to the Find Referrals and Appointments screen 3. Otherwise, click on Referrals and Appointment Queues. 8 4. Enter the search criteria. Click Search. The matching referral(s) will be displayed. 5. Click the Select button next to the referral tracking number. The Referral Action screen will be displayed. 6. You can print the consultation form, edit the referral, view appointment information, post notes, and view all history. ... contact CARCU? 1. Find the referral and view the complete referral history at the bottom of the consultation form. This referral history will show "who,what,when" at every stage of the referral handling process. 2. If you still feel you need to contact a person in CARCU, click on the Contacts tab for a list of CARCU staff with phone numbers. … find a referral? 1. Click on the Refer(PCP) tab. 2. If you know the referral’s tracking number, the patient name, the medical record number, or the social security number, click on Find Referrals. This will take you to the Find Referrals and Appointments screen 3. Otherwise, click on Referrals and Appointment Queues. 4. Enter the search criteria. Click Search. The matching referral(s) will be displayed. … log on? 1. From Internet Explorer browser, enter www.reftrak.com in the address field. 2. You need to be pre-authorized in order to submit or retrieve patient information. When the RefTrak home page appears, enter your user name and password. If this is the first time you log on to RefTrak you will be asked to change your pre-assigned password to your personal password. The password must have at least 7 characters. … get to the Consultation Form? 1. Find the referral via the Find Referrals and Appointments screen or the Referral and Appointment Queues screen. 2. Click on Select button next to the referral you are interested in. 3. The Referral or Appointment Actions screen will be displayed. The Consultation Form for that referral is on the bottom of the page. ... print a screen? 1. Use your browser's File Print function to print any screen at any time. 9 2. If you are in a page which has a Print icon, click on the icon to print the report or other document without printing the rest of the screen. ... respond to CARCU requests for confirmation, changes, etc.? 1. Click on the Refer(PCP) tab. Click on Referral and Appointment Queues. 2. Choose "Awaiting PCP Action" Status. Choose your clinic(s) in Refer By. Click Search. A list of referrals needing your action will be displayed. 3. Click on any Referral. The Referral Action screen will be displayed. You can complete the appropriate referral or appointment actions. The "right" action will usually be first in the list. ... submit a referral? 1. Click on the Refer(PCP) tab. 2. Click on Submit Referral. This will take you to the Referral Wizard. 3. Fill in the information in each section of the Wizard, including any attachments which will be sent by mail or fax, then click Submit. 4. The referral is now submitted with a referral tracking number. You can print the consultation form and use it as the cover page for any additional faxed documents. 10 What Is? …Action An action is executed when a user selects an item from the Action list box or by clicking on a command such as “Add An Appointment”. If the action was an “Edit”, the appropriate screen will open up for editing purposes. If the action was to indicate that an event happened such as “Progress Notes Sent”, simply click on the item on the drop down Action list box, then click on the Update Referral button. RefTrak system will change the referral and appointment status to the appropriate value. Appropriate actions are driven by the current status of the referral and appointment and by the role of the logged in user. For example: If the logged in user is a coordinator from CARCU, the action box will include more actions than if the user is from a referral clinic. …Action Agent Action agent is a program run by CARCU to change the status of referrals and appointments en-mass. For example: the Close Referral Agent will select referrals whose appointment dates have passed and no activities are recorded in the last 60 days. …Action History Action History is a chronological log of changes made to a referral and its appointments. For example, when a referral’s status is changed from ‘Submitted’ to ‘Oked’, the Action History shows when the action took place, who initiated the action, what the new status is, any notes made by the user regarding this action, and an audit trail of what happened behind the scene if any. The Action History is displayed at the bottom of the Consultation Form. …Appointment Call List and Letter The Appointment Call List lets you create a list of appointments along with the patient’s contact information based on an appointment date range. The Appointment Letter lets you create the letters addressed to each patient on the selected list. Note that if the referral indicates that the patient needed an interpreter, the letter will be printed in the requested language automatically if the letter is available in that language. 11 …Attachment Attachment can be a document on the user computer, sent to RefTrak along with the referral. It can also be a notation to tell the CARCU that support documents are being sent via fax, or regular mail. Attachments are added through the Diagnosis/History tab of the Submit Referral Wizard. …Appointment Status Appointment Status is a field kept in the database to indicate which stage the appointment is currently at. For example: When an appointment is scheduled initially, the appointment’s status is set to ‘Scheduled Referral. An appointment status may be changed in one of the following ways: o An action taken by a user via the Referral Action screen. o A program (also called an Agent) is run to change the status of all appointments meeting some predetermined criteria. For example, an Agent may be run to select all appointments whose appointment date has passed and turn the status to “Show?” to indicate that it is assumed the patient probably showed up for the appointment. This allows a CARCU staff to only deal with the no-show cases individually. …Consultation Form The Consultation Form is a summary of information regarding the referral and its appointments. At the bottom of the form is the Action History. Whenever a referral is selected from the Find Referrals and Appointment screen, or the Referral and Appointment Queues, the Consultation Form is displayed. …Follow-Up Appointment – Pending Authorization After seeing a patient, the specialty physician may request CARCU to schedule follow-up appointments. Depending on the patient’s insurance carrier’s policy, CARCU may have to get authorization from the referring clinic for these appointments. In this situation, CARCU would schedule an appointment pending authorization from the PCP. …Request Patient Call Back to Schedule Appointment After seeing a patient, the specialty physician may request CARCU to schedule follow-up appointments, but expect the patient to call CARCU to make confirm this request . CARCU may go ahead and reserve an 12 appointment on the book for the follow up appointment but will wait for the patient to call before finalizing the appointment. …Refer From Unit Refer From Unit is the primary care organization, referring the patient to the specialty clinic. …Referral Status Referral Status is a field kept in the database to indicate which stage the referral is currently at. For example: When a referral is submitted initially, the referral status is set to “Submitted”. A referral status may be changed in one of the following ways: o An action taken by a user via the Referral Action screen. o An action taken by a user on an appointment, which causes the RefTrak system to change the referral status automatically. For example, when an appointment is added, the RefTrak system changes the referral status to “Scheduled Referral” automatically. o A program (also called an Agent) is run to change the status of all referrals meeting some predetermined criteria. For example, an Agent may be run to select all referrals whose appointment’s time have been passed for at least 6 months and turn the status field to ‘Closed’. …Refer To Specialty In the RefTrak Wizard where the user fills out the referral information to submit a referral, Refer To Specialty is the specialty clinic the patient is being sent to. …Refer To In the Referral and Appointment Queuesscreen, the Refer To drop down list box includes the individual specialty clinics and groups of clinics assigned to specific coordinators in CARCU. Similar to Status Group, the Refer To groups help the users quickly select referrals sent to a group of clinics. For example, “CARCU Ruth Primary” includes in its collection all referrals sent to the specialty clinics Ruth is responsible for. …Status 13 Status is a field kept in the database to keep track of which stage a referral or an appointment is in at the current time. Please see the definition of Referral Status and Appointment Status for further details. …Status Group A Status Group is a collection of statuses. Status Group is used on the Referral and Appointment Queues screen to help the users quickly select referrals specified by a group of statuses without having to specify the status one by one. For example, status group “Awaiting Scheduling Office Action” will include in its collection all referrals whose current status indicates that someone in CARCU needs to act on in. …Submit Referral Wizard Submit Referral Wizard provides the step by step procedure the user follows to submit a referral. …Tracking Number Tracking number is a unique number assigned to a referral when a user submits the referral. This number is printed on the Consultation Form. Please write this number on any support documents sent to CARCU subsequently. …Work Flow Diagram There are two Work Flow Diagrams: one for referrals and one for appointments. A Work Flow Diagram is generated by a program in RefTrak to display the stages (hence the status) a referral and an appointment may progress to, based on the Action taken at each stage. The RefTrak administrator can generate a copy of the work flow diagram by running a program listed under the Admin tab. 14 Reports Outcome Metric Reports are summary of referrals based on a number of predetermined criteria such as Referrals by Payor, Time out to Appointments, Referrals by Specialty Clinics etc. Code Tables Code tables are maintained by the RefTrak Administrator. At any time, the RefTrak Administrator can get an up to date copy online. Please refer to RefTrak Administrator Guides for instructions pertaining to administrator actions. Sample of Status Group Table A Status Group includes referrals and appointments whose status is in the list. Status Group Status Abbrev Cancelled/NoShow Appointments Cancelled Cancelled/NoShow Appointments NoShoAcked Cancelled/NoShow Appointments DeclineAcked Cancelled Referrals XAcked Awaiting Scheduling Office Action Submitted Awaiting Scheduling Office Action Held Awaiting Scheduling Office Action EscalatedCln Awaiting Scheduling Office Action OKedCnd Awaiting Scheduling Office Action OKed Awaiting Scheduling Office Action SubmittedU Awaiting Scheduling Office Action XReqd Awaiting Scheduling Office Action Showed? Awaiting Scheduling Office Action ScheduledCnd Awaiting Scheduling Office Action Delegated Awaiting Scheduling Office Action EscalatedAdm Awaiting Scheduling Office Action ChgReqd Awaiting Scheduling Office Action CallBackReqd Awaiting Scheduling Office Action New Awaiting Scheduling Office Action Declined Closed Referrals Closed Completed Appointments RsltAcked OK - No Action Pending Scheduled Awaiting Primary Care Clinic Action TempSaved Awaiting Primary Care Clinic Action SchedPndAuth Awaiting Primary Care Clinic Action Scheduled Awaiting Primary Care Clinic Action RsltUnAcked Status Descr Cancelled Appointment Patient No-Show Acknowledged Follow-Up Decline Acknowledge Cancelled Referral Acknowledged Submitted Referral Held Referral - Corrections Pending Escalated Referral (Clinical) Conditionally Approved Referral - Prereq Pend Approved Referral Pre-Scheduled Urgent Appointment Cancel Appointment Requested Appointment Passed - Show/Noshow Unknown Conditionally Scheduled Referral Delegated Referral Escalated Referral (Admin/Billing) Change Requested to Confirmed Appointment Patient Call Back Requested New Appointment - Unscheduled Follow-Up Authorization Declined Closed Referral Completed Appointment Results Acknowledge Scheduled Referral Temporarily Saved Appointment Unsubmitted Scheduled Follow-Up Appointment - Authoriza Unconfirmed Appointment Completed Appointment Results Unacknowled 15 Awaiting Primary Care Clinic Action XUnAcked Cancelled Referral Unacknowledged Awaiting Primary Care Clinic Action TempSaved Temporarily Saved Referral Unsubmitted Awaiting Primary Care Clinic Action RejUnAcked Rejected Referral Unacknowledged Awaiting Primary Care Clinic Action New New Referral Unentered Awaiting Primary Care Clinic Action NoShoUnAcked Patient No-Show Unacknowledged Awaiting Primary Care Clinic Action XUnAcked Cancelled Appointment Unacknowledged Pending Appointments Confirmed Confirmed Appointment Rejected Referrals RejectAcked Rejected Referral Acknowledged 16 Sample of Action Table The Action table includes actions a user can take to move the referral or appointment to another status. Only actions appropriate at the current status and those the logged in user is authorized to do are displayed in the Action Drop Down list box. Appt/Ref Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Appointment Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Action Descr Acknowedge No-Show Acknowledge Appointment Cancellation Acknowledge Decline Authorize Follow-Up Appointment Cancel Appointment Change/Reschedule Appointment Confirm Appointment Confirm Appointment Results Received Correct Appointment Decline Authorization for Follow-Up Appointment Indicate Appointment Results Sent Indicate Appointment Time Passed Indicate Patient No-Show Request Cancellation of Appointment Request Cancellation of Confirmed Appointment Request Change/Reschedule to Confirmed Appointment Request Patient Call Back to Schedule Follow-Up Appointment Rescind Change Request (Never Mind) Reverse NoShow Appointment Action Schedule Follow-Up Appointment - Authorization Required Schedule Appointment Schedule Follow-Up Appointment After Patient Call Back Schedule Urgent Appointment Submit Urgent Appointment Temporarily Save Appointment Without Submitting Acknowledge Cancelled Referral Acknowledge Rejection Annotate History Approve Delegated Referral Approve Escalated Referral (Admin/Billing) Approve Escalated Referral (Clinical) Approve Referral Cancel Referral Cancel Temporarily Saved Referral Clear Referral Prerequisites 17 Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Close Referral Conditionally Approve Escalated Referral (Admin/Billing) Conditionally Approve Escalated Referral (Clinical) Conditionally Approve Referral Delegate Referral Coordination Responsibility Edit Referral Escalate Referral (Admin/Billing) Escalate Referral (Clinical) Reject Delegated Referral Reject Escalated Referral (Admin/Billing) Reject Escalated Referral Pending Correction (Clinical) Reject Referral Pending Correction Rejected Following 10 Day Hold Resubmit Held Referral With Corrections Save Without Submitting Schedule Conditional Referral Schedule Referral Submit Sample of Status Table The Status table includes appointment statuses and referral statuses Appt/Ref Abbrev Appt CallBackReqd Appt Cancelled Appt ChgReqd Appt Confirmed Appt DeclineAcked Appt Declined Appt New Appt NoShoAcked Appt NoShoUnAcked Appt RsltAcked Appt RsltUnAcked Appt SchedPndAuth Appt Scheduled Appt Showed? Appt SubmittedU Appt TempSaved Appt XReqd Descr Patient Call Back Requested Cancelled Appointment Change Requested to Confirmed Appointment Confirmed Appointment Follow-Up Decline Acknowledge Follow-Up Authorization Declined New Appointment - Unscheduled Patient No-Show Acknowledged Patient No-Show Unacknowledged Completed Appointment Results Acknowledged Completed Appointment Results Unacknowledged Scheduled Follow-Up Appointment - Authorization Required Unconfirmed Appointment Appointment Passed - Show/Noshow Unknown Pre-Scheduled Urgent Appointment Temporarily Saved Appointment Unsubmitted Cancel Appointment Requested 18 Appt Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral Referral XUnAcked Closed Delegated EscalatedAdm EscalatedCln Held New OKed OKedCnd RejectAcked RejUnAcked Scheduled ScheduledCnd Submitted TempSaved XAcked XUnAcked Cancelled Appointment Unacknowledged Closed Referral Delegated Referral Escalated Referral (Admin/Billing) Escalated Referral (Clinical) Held Referral - Corrections Pending New Referral Unentered Approved Referral Conditionally Approved Referral - Prereq Pending Rejected Referral Acknowledged Rejected Referral Unacknowledged Scheduled Referral Conditionally Scheduled Referral Submitted Referral Temporarily Saved Referral Unsubmitted Cancelled Referral Acknowledged Cancelled Referral Unacknowledged 19 20
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