NEW - Culinary health fund

SimonMed accepts Culinary Health Fund (HCP15074IN) patients in Southern Nevada.

Patients DO NOT REQUIRE AUTHORIZATION and should be scheduled during the earliest available appointment.

The only patient responsibility will be a co-pay for:

X-Ray/US          $20 per visit

MRI/CT              $125 per visit

PET/NM             $175 per visit

MG/DX               $0 per visit

NOTE: These have been updated in Simplicity 

STAT GUIDELINES

STATS we do try to accommodate same day next day, if it requires auth we schedule out 4 hours or next AM so auth has time to attempt to obtain.

We check the location most convenient to the pt but if we see no openings we offer surrounding sites that may have openings, if surrounding do not have openings as well we are ok to double book following the below guidelines.

*Agents do not have rights to double book so if this occurs they are reaching out to their leads to do the double booking at which time the leads can check thru to make sure it’s an ok spot to add.

If they double book  they should be notifying the patient they are being worked in and may have a wait and notate this was communicated.

A call must be placed to the site only if the following circumstances apply:

·         Clinic/modality is closing within the hour. Example you get call at 3:15pm and that modality closes at 4pm.

·         We are already double-booked and you are needing to add another exam. Example we have two 4pm and you need to add a 3rd (Triple Booking).

·         Only overbook non contrast spots.  Please ensure contrast coverage is available if you are booking a contrast exam.

·         If you are scheduling a specialty exam, there may be limits on certain exams such as: Arthrograms, Fluoro, Diagnostic Mammo’s, Nuc Med, Etc. You must call the site for approval.

·         If you are scheduling an exam that requires authorization please make sure you inform the patient that if authorization is not received by the time of the exam, their appointment   may be postponed. Allow 4 business hours’ time for auth to be obtained.

·         Same day Saturday appointments that require auth must already have auth on file or the patient will not be able to be seen. If exam requires authorization and it has not already been obtained please schedule for Monday to allow time to obtain STAT auth.  

When scheduling the below STAT exam, these cannot be done after 5pm or on weekends.

CTA CHEST WITH CONTRAST W/3D RECON AND THE DIAGNOSIS IS FOR PE (PULMONARY EMBOLISM)

US DUPLEX SCAN LOWER EXTREM VEINS BILATERAL

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (LEFT)

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (RIGHT)

US DUPLEX SCAN UPPER EXTREM VEINS BILATERAL

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (LEFT)

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (RIGHT)

OB ULTRASOUNDS FOR VIABILITY

If you are “postponing scheduling” until the next business day please send recap form to the Dr office to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

If you are “postponing scheduling” on a Friday until Monday please send recap form to the Dr office as well as call to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

COURTESY CALL BACK FEATURE

SimonMed offers a feature to our callers for us to call them back if they do not wish to wait on hold for an agent. The system will give them this option in the IVR as they are waiting for their call to be answered, if they elect to do this it will confirm the number and then hold their place in line, the caller can then disconnect.

When it is their turn, the system will present the call as an inbound call to the next available agent. Once the agent answers, the system will then dial the call back number as if the agent picked up the phone and dialed the number to call this patient back.

When this feature occurs you will be presented a pop up box for that call that reads Courtesy Callback. You should wait on the line for the system to dial the patient, if the patient answers your verbiage should reflect that you reached out to handle their needs. If a voicemail comes on we should execute one letting them know we were calling to ensure their needs were taken care of.

Please do not hang up when you answer these calls and no one is on the other line.

To recap:

What is a courtesy call back?

Ø  When a patient calls in and does not want to wait on hold they have the option for a call back and not lose their place in line.

Once it is the callers turn that we held for them the system will connect an incoming call to an available agent, then dial the pts phone number to connect.

Ø  Agents are connecting, but not allowing the system to attempt the call back, or hearing ringing because the system did make that call back and then hanging up.

 Please make sure that you wait on the line for an answer and if caller connects “Hi this is Mariah with SimonMed Imaging we are reconnecting with you to handle your needs.” If a voicemail comes on we can leave the same message, “Hi this is Mariah with SimonMed Imaging we are reconnecting with you to handle your needs, if have not yet been helped please call us back at 866-614-8555”.

Blind transferring

Please do not blind transfer to sites or other departments directly.

If a caller needs to speak with someone located at the site or in another department the call needs to be warm transferred.

Do not give out employee’s last names.

We should not be blind transferring over to the RAD hotline.

If you can’t reach the site please reach out to your lead for assistance.

The only exception to this is if you are transferring to a queue only such as PFS, Auth, etc. 

Remember team we need to focus on the quality of the call. 

Patient complaints

Please see below on who to send complaints to based on the department the complaint is related to.

Site Complaints –

·         Site Manager

·         Regional Manager

General Scheduling Complaints –

·         Scheduling Lead

·         Scheduling Supervisor

Concierge Scheduling Complaints –

·         Concierge Scheduling Lead

·         Concierge Supervisor

Auth Complaints –

·         Auth Supervisor

·         Auth Manager

PFS Complaints –

·         PFS Manager

Billing complaints – 

·       Change Healthcare 888-976-7781- DOS After 10/01/2022

·    pasupport@padepartment.com or 888-280-1238 - DOS before 10/01/2022

If the supervisor or manager cannot handle the complaint they will escalate to the appropriate party.

If the patient calls in and asks to speak to someone higher than the supervisor or manager please make sure to reach out to the supervisor or manager for assistance on who to transfer the call to.

Please do not transfer patient complaints to Compliance.

Compliance should only be handling HIPAA violations.