About the Federally Qualified Health Center

Federally Qualified Health Center (FQHC) in the United States is a non-profit entity comprising of clinical care providers, that operate at comprehensive federal standards. The care providers in FQHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. This client is the health care safety net for their county’s poor and uninsured people. The FQHC gives the people access to high-quality health services that they needed and deserved. They are key regional health providers who treats more than 65,000 patients annually.

Challenges in the existing referral workflow of HealthViewX Federally Qualified Health Center client

The following are the major problems our Federally Qualified Health Center client wanted a solution for. Let us consider the challenges with a typical referral scenario to understand it better.

1. Insurance pre-authorization – The physician must check the pre-authorization requirements, health plans, etc. He must retrieve patient-specific data like the history of medications, medical diagnosis and insurance coverage. The physician must then send it to the insurance company so that they can validate the same. This client did not a dedicated team or software to do insurance pre-authorization which increased their burden.
2. Tracking the referral – Specialists are usually busy. They do not have the time to inform physician’s about the progress of referrals. So the physicians are unable to track referrals. They get no information about appointments, referral loop closure or feedback from specialists or patients.

How HealthViewX features helped this FQHC client resolve their challenges

Considering the existing workflow of the FQHC, their major problems are insurance pre-authorization and referral tracking. So how can HealthViewX Patient Referral Management solution help in solving these problems?

The following features made the pre-authorization  and referral communication easier for this FQHC client,

1. EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
2. Insurance pre-authorization automation –  There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the api-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the form automation method.  Through this, we get all payer-specific form, fill in the necessary information and send it to the insurance company via efax
3. To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications. By this, the physicians can get referral updates easily.

Useful HealthViewX Patient Referral Management Solution features

Leading FQHC in California has chosen HealthViewX due to the industry-leading patient referral management features. FQHCs across USA can benefit from Referral Management Software depending on their patient referral workflow,

• Intelligent Provider Match
• HIPAA compliant data security
• Referral history
• Referral loop closure

HealthViewX Patient Referral Management software has provided the best use cases for the major challenges faced by the FQHC. Are you a Federally Qualified Health Center missing out on your referral updates? Schedule a demo with us to know more about our solution.