| CALL TYPE | KEY PHRASES | TRANSER OR OTHER | WARM OR COLD TRANSFER | ACTION | RELEVANT CALL SCRIPTS | SPECIAL INSTRUCTIONS |
|---|---|---|---|---|---|---|
| Patient Access | ||||||
| Schedule Appointment- New Patient | -New patient, not established | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If it has been more than 2 years since last PCP visit, patient is now INACTIVE and should be treated as a new patient. If the patient is INACTIVE, refer to New Patient/Returning Inactive Patients Checklist to complete registration. | -New Patient/Returning Inactive Patient Checklist | |
| Schedule Primary Care Appointment - Established Patient | -"I need to schedule an appointment with my provider." -Pediatrics -Family -Internal medicine -HIV/HCV -Women's health -GEM -Transgender, HRT (Hormone Replacement Therapy) | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If INACTIVE: Should be treated as a New Patient; refer to New Patient/Returning Inactive Patients Checklist. -If ACTIVE: Refer to General Scheduling Call Script. | -General Scheduling Call Script -New Patient/Returning Inactive Patients Checklist | ESTABLISHED PATIENTS are patients that have been seen by their PCP within the last 2 years. Patients that have not been seen (REGARDLESS of missed/canceled appointments) are not considered established patients and should be treated as a new patient when scheduling. |
| Schedule Medicare Annual Wellness Visit, Schedule Annual check-up, Schedule Annual physical | -"I received a message to schedule" -"I would like to schedule my Medicare annual wellness" -MAWV, AVW, -Annual check-up, physical, well women's exam | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If INACTIVE: Refer to New Patient/Returning Inactive Patients Checklist. -If ACTIVE: refer to the Annual Visit Scheduling Call Script. | -Annual Visit Scheduling Call Script -New Patient/Returning Inactive Patients Checklist | |
| Schedule Appointment with Medical Specialty Service | -Diabetes -Clinical Pharmacy -Nutrition -Dietician -Travel Medicine -Weight Management -PrEP/PEP/STI Testing | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -INACTIVE: Should be treated as a New Patient; refer to New Patient/Returning Patients Checklist. -ACTIVE: Refer to the Scheduling Medical Specialty Service Call Script. | -New Patient/Returning Patient Checklist -Scheduling Medical Specialty Service Call Script | |
| Scheduling - Behavioral Health - Therapist | -Appointment cancellation -Reschedule -Change - Telemed request and appointment | No | N/A | -If patient is asking to cancel/reschedule, cancel appointment in Athena. For rescheduling, send patient case to appropriate therapist staff box for BH provider to call and schedule/reschedule appointment. -If patient is asking to switch appointment delivery method (for example, from in person to telehealth), make this change on existing appointment. | ||
| Scheduling Initial Appointment- Psychiatry Services | -Missed a call to schedule initial psychiatry appointment -I have a referral for psychiatry services | No | N/A | -For patient's calling to schedule an initial appointment, call center should review patient's chart looking for open patient case with instructions from clinical staff on scheduling (clinic staff will initiate all scheduling of new patients). -If patient case with scheduling instructions is present, call center agents can schedule as directed. -If no patient case containing scheduling instructions is found, call center will send patient case to psychiatrymedmngt Athena box for clinic staff to follow up with patient. | ||
| Canceling and rescheduling existing appointment - Psychiatry Services | -Appointment cancellation, reschedule, change appointment | No | N/A | -If the patient is cancelling an appointment and does not want to reschedule at this time, call center agent will cancel appointment in Athena and send patient case informing clinical staff of the cancellation to the appropriate provider staff box. -For rescheduling, call center can reschedule the existing appointment using the 'Reschedule Appointment' function within Athena. Rescheduled appointments MUST be exactly the same in appointment length and appointment service delivery method (for example, a 40 min in-person follow up cannot be changed to telehealth or any length other than 40 mins). -If patient is requesting a change to appointment length or appointment service delivery method, call center agent are not allowed to make any changes to existing appointments but should send patient case to appropriate provider staff box. | -Rescheduling and Canceling Appointment Call Script | |
| Patient or Hospital calling to schedule Psychiatric hospital follow up | -"I was recently hospitalized for a Psychiatric need" -SCC patient was recently hospitalized and we want to set up a follow up appointment | N/A | N/A | -If a patient is hospitalized for a psychiatric need, the call center should create an urgent patient case and send it to the psychiatric provider's staff box for follow-up, marking it as urgent. | -Scheduling Hospital Follow Up Call Script | |
| Patient or hospital staff member calling to schedule ER/hospital follow up Note: Hospital staff include discharge coordinators, case managers, care coordinators, nursing staff, hospital liaisons | -"I/Patient was recently hospitalized" -"I/Patient have been discharge form the hospital and need a follow up appointment" | N/A | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If ACTIVE, refer to the Scheduling Hospital Follow Up Appointment Call Script. -If the patient is INACTIVE, inform caller that patient is not an active SCC patient and send a patient case , marked urgent, to the appropriate clinic patient navigator Athena box and inform caller that staff will be in touch within 1 business day. | -Scheduling Hospital Follow Up Call Script | |
| Established patient of a provider who is still employed at SCC wants transfer of care (TOC) to a different SCC provider | -"I would like to change to a different SCC provider." | No | N/A | Confirm patient's chart is listed as ACTIVE. -If INACTIVE, treat as a new patient wanting to establish care and refer to the New Patient/ Returning Patient Checklist. -If ACTIVE, check for an existing patient case regarding TOC: -If patient case exists, schedule as directed, or update existing patient case and leave in current box. -If no patient case exists, create a patient case and send to the clinic manager of the location of the patient's current provider. | -New Patient/Returning Patient Checklist | |
| Established patient of a provider who has left SCC wants a transfer of care (TOC) to a different SCC provider. | -"My provider has left SCC" -"I want a new provider" -"I'm an established patient but do not have a provider at the moment." | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If INACTIVE, treat as a new patient wanting to establish care and refer to the New Patient/ Returning Patient Checklist. -If ACTIVE, attempt to to schedule the patient with a provider who is accepting new patients. If the patient does not want to establish with a provider who is accepting new patients, call center should place patient on the Athena Waitlist. Agent should review patient chart to see if there are any patient cases detailing or requesting scheduling. If patient is symptomatic follow Symptom call type instructions. | -General Scheduling Call Script -New Patient/Returning Inactive Patients Checklist -Creating Patient Cases and Adding Patients to the Appointment Waitlist & Ticklers in Athena | |
| Patient has appointment but is missing Telehealth Link | -"I have a telehealth appointment" -Online appointment -Virtual appointment -"I don't have a link." | No | N/A | Verify correct contact information. Resend Telehealth Link to patient via Athena Quickview. | ||
| Patient Calling to Reschedule Existing Appointment | -Wanting sooner appointment -Verifying they are on waitlist -Asking for updated time frame | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If ACTIVE Refer to the Rescheduling and Cancelling Existing Appointment Call Script. -If INACTIVE, treat as a new patient wanting to establish care and refer to the New Patient /Returning Inactive Patients Checklist. | -Rescheduling and Cancelling Existing Appointments Call Script -Creating Patient Cases and Adding Patients to the Appoinment Waitlist & Ticklers in Athena | |
| Patients Needing Pre-Op Clearance for Surgery | -"I need a preop clearance for surgery" -"I'm having surgery and I was told to get an appointment with my primary care provider first" | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If INACTIVE, treat as new patient wanting to establish care and refer to the New Patient/Returning Inactive Patients Checklist. -If ACTIVE, schedule pre-op appointment with the assigned usual primary care provider. If the appointment is too far out and the patient needs an earlier appointment due to the surgery date, please send a patient case to the usual provider staff box, including date of surgery. | -New Patient/Returning Inactive Patient Call Script | |
| HIV or Hepatitis HCV Intake | -New HIV/HCV diagnosis -Hospital follow up after HIV/HCV diagnosis; -Patient is new to New Mexico; moving from out of state -Accessing care for HIV | Yes | WARM TRANSFER | Confirm if patient has an Athena chart. If they do have an Athena chart, send patient case describing patient request for HIV or HCV care and with confirmed contact info to appropriate HIV/HCV Intake Case Manager. If patient does not have an Athena chart, attempt warm transfer to appropriate HIV/HCV Intake Coordinator, if no answer please instruct patient to leave detailed voicemail including name, request and callback number. Appropriate Intake Coordinator should be based on city in which patient is requesting services. | Samantha Trujillo: 1513 Irene Berenstein:1024 | |
| Patient Calling to Schedule Vaccine Request | -Flu -Covid -Pediatric vaccine -RSV (Respiratory Syncytial Virus) -Pneumonia -Any Other Vaccines | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If INACTIVE and patient is in Santa Fe, advise patient that routine vaccines can be received through our SCC Santa Fe pharmacies. If Inactive, ask Patient if they would like to reestablish care at SCC. IF so follow New Patient/ Returning Patient Checklist. -If ACTIVE and patient wants any vaccine other than measles/MMR, proceed to scheduling appropriately according to Vaccine Scheduling Guidelines. -If ACTIVE and patient is an adult requesting measles/MMR, send patient case to the appropriate clinic RN box and inform patient a nurse will call them back to discuss further. | -New Patient/Returning Inactive Patient Checklist -Vaccine Scheduling Guidelines | |
| Fibroscan | -Fibroscan | No | N/A | Verify referral for Fibroscan in patient chart. -If no referral exists, follow referral request process. -If referral exists schedule into a Nurse Visit according to the Nurse Visit Scheduling Template per site. The scheduler must advise the patient that they need to fast for 3 hours prior to the appointment, and provide directions. | -Referral Call Script | |
| Patients seen at SCC within the past 3 months for PrEP who are requesting to schedule or reschedule their next PrEP appointment. | -I need a follow up appointment for my PrEP medication -I need to schedule a PrEP appointment -I need to reschedule my PrEP appointment | Refer to PrEP/PEP/STI Call Script to determine if patient can be scheduled or needs to be transferred to triage nursing. | -PrEP/PEP/STI Call Script Triage Extension: 2024 | |||
| Patients reporting sexual exposure or unprotected sex who are requesting STI screening or PEP, and patients interested in starting PrEP who have either never been seen at SCC for PrEP or whose last PrEP visit was over 3 months ago | -I need to schedule appointment for STI check -I had unprotected sex/condom broke, -I need emergency HIV meds, I want the HIV prevention pill -I had a needle stick accident/used someone else's needle -I had a sexual encounter with someone who has HIV / STIs -My partner is HIV positive, I need something to protect me from STIs/HIV before sex -Do you offer Truvada/Descovy for prevention? | Yes | WARM TRANSFER | Refer to PrEP/PEP/STI Call Script to determine if patient can be scheduled or needs to be transferred to triage nursing. | -PrEP/PEP/STI Call Script -Triage Extension: 2024 | Pt cannot deny triage. Must warm transfer, if no answer send pc. |
| Question about Referral | -I have a question about an existing referral. | Yes | WARM TRANSFER | -Review patient chart for open referral. Transfer to appropriate clinic referral specialist. If not available, create patient case and send to referral specialist. -If no referral exists, schedule patient with usual provider for visit (treat as new referral request). | -Referral Call Script ABQ Referral Specialist: 1505 Santa Fe Referral Specialist: 1400 | |
| New Referral Request | -I want a referral | No | N/A | Verify patient has previously discussed referral request with provider by asking patient. -If yes, then create patient case detailing request and send to appropriate nurse box. -If no, then patient needs to schedule appointment with usual provider. | -Referral Call Script | |
| Clinical Concerns | ||||||
| Patients Calling to confirm what will be covered in upcoming appointment | -Will my child be vaccinated in this appointment? -Will the provider prescribe a particular medicine? | No | N/A | -Confirm patient has scheduled appointment. If so, inform patient that "clinical decisions about patient / patient's child's treatment will be discussed and decided by the provider in the visit. You are encouraged to ask questions about your care during your appointment." -If patient is calling to change the reason for visit, ensure that the currently scheduled provider is still appropriate for reason based on provider scheduling template. If so, update reason for visit. If not, reschedule patient with appropriate provider per scheduling templates.
| ||
| Symptoms- EMERGENCY | -New onset chest pain / pressure -throat tightening or swelling, -New onset shortness of breath or difficulty breathing -Altered mental status, confusion, acute vision loss, difficulty speaking or slurred speech -Sudden loss or change of mobility in Face Arm Leg Speech Tongue -New onset Seizure -Poison ingestion or drug overdose -Head injury with open wound or loss of consciousness -Traumatic injury/excessive bleeding -Motor Vehicle Accident -Unwell "floppy" infant | No | N/A | DIRECT PATIENT TO HANG UP AND CALL 911 IMMEDIATELY OR GO DIRECTLY TO THE NEAREST EMERGENCY ROOM. -After directing patient to call 911, or seek urgent medical attention - create patient case in Athena, mark as urgent and send to nurse Triage for follow up. -Do not inform patient that triage will be calling them as this may encourage the patient to wait for that call instead of going to emergency services. | Pt cannot deny triage. Must warm transfer, if no answer send pc. | |
| SYMPTOMS: Non-emergency (Non emergency are ANY symptoms not listed under emergency symptoms) | -"I have new symptoms" -"My medication(s) is/are making me feel bad" -"I'm worried about my [symptoms]" -"I feel anxious/depressed." Symptoms can be physical or mental. | Yes | WARM TRANSFER | Confirm if patient is active or inactive. -If active, warm transfer to Triage Nurse and send patient case to Triage Nurse Athena box, if no answer for warm transfer attempt, send patient case to the Triage Nurse. -If INACTIVE, direct patient to call their primary provider or go to emergency services if they need immediate support. Do not transfer Inactive or Prospective patients to the Triage Nurse. For inactive patients, ask if the patient wishes to become a new patient. Refer to the New Patient/Returning Inactive Patients Checklist. | -New Patient/Returning Inactive Patients Checklist -Triage Extension: 2024 | Pt cannot deny triage. Must warm transfer, if no answer send pc. |
| Calls from patients after 4:45 PM that should be routed to the triage nurse | -I want to talk to triage nurse -Patient calling expressing any type of symptoms | No | N/A | If a patient calls with symptoms after 4:45 PM and needs to be referred to a triage nurse, inform them that their case will be sent to the triage nurse, but they may not receive a call until the next business day. For instance, if they call on Friday at 4:45 PM, they won't hear back until Monday. If the patient insists on immediate attention and cannot wait, advise them to go to urgent care or the emergency room. | Pt cannot deny triage. Must warm transfer, if no answer send pc. | |
| Suicidal or Homicidal Patient | -I want to hurt/kill myself -I want to hurt/kill others -I want to die -I'm going to kill myself | Yes | WARM TRANSFER | Attempt transfer to appropriate clinic nursing extension. -If no answer within 30 seconds, attempt transfer to triage nurse extension. Do not delay transfer to have a discussion with the caller. Politely ask them to wait while you get someone for them to speak with. | Triage Extension: 2024 Jefferson:2021 Harkle:2022 Galisteo:2023 | Pt cannot deny triage. Must warm transfer, if no answer send pc. |
| Nurse / Clinical Question (non-symptom related) | -I have a question about something I discussed with my provider during my last visit -My provider told me to call and speak with a nurse -I have a question about (lab/imaging results) -How to take my medications, injections, (provider recommendations). -Any patient stating I need to speak with a nurse but who does not have current symptoms. | No | N/A | Send detailed patient case to the appropriate clinic RN box. -IF patient states concerns about timeliness of call back, inform patient that a nurse will call back within 3 business days. At any time if the caller mentions symptoms, refer to instructions to transfer call to triage nurse. | ||
| Critical Lab Results | 3rd party call from vendor/laboratory, or imaging center to convey a "CRITCAL LAB RESULT" | Yes | WARM TRANSFER | Keep caller on-line and warm transfer to appropriate clinic registered nurse extension. IF NO ANSWER, attempt warm transfer to Triage nurse extension. Continue warm transfer attempts until you are able to link with an SCC nurse. Do not disconnect call. A licensed individual is required to take this call. | Triage Extension: 2024 Jefferson:2021 Harkle:2022 Galisteo:2023 | |
| Medication Request (New Medication or Current Medication Refill) | -Any medication request -I need a new medication -I am out of my medication/I need a refill -My pharmacy says I have no more refills -My pharmacy didn't receive the prescription -The wrong dose of my medication was sent -My medication was sent to the wrong pharmacy -I want to transfer the pharmacy my meds are filled at | No | N/A | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If INACTIVE and should be treated as a New Patient; refer to New Patient/Returning Inactive Patients Checklist. -If ACTIVE: Refer to Medication Inquiry Call Script to either schedule appointment with appropriate provider (for new med) -If ACTIVE: Process medication refill request send to Onpoint. | New Patient/Returning Inactive Patients Call Script Medication Inquiry Call Script | |
| Medication Needs Prior Authorization Approval | -Medication insurance approval or denial -Prior or pre authorization required. -My pharmacy said insurance won't cover my medication. | No | N/A | Confirm if patient is: -If INACTIVE: Should be treated as a New Patient; refer to New Patient / Returning Inactive Patients Checklist. -If the patient is ACTIVE, confirm the medication in question was prescribed by an SCC provider. If the medication was prescribed by an SCC provider, look for open patient case regarding 'prior authorization request' and update that patient case with info from patient phone call; mark patient case urgent. -If no patient case regarding a prior authorization can be found in chart, create a patient case in Athena and send it to the 'pharmacypa' Athena box. Create a patient case & gather as much information as possible, including the following:
If any documents need to be faxed over, ask what documents are required and what the fax number is. | New Patient/Returning Inactive Patients Call Script | |
Medication inquiry from an external provider, pharmacy, or specialty pharmacy | Medication question, clarification | Yes | WARM TRANSFER | Confirm patient has an Athena chart. Transfer call to the appropriate clinic nurse extension. | Jefferson:2021 Harkle:2022 Galisteo:2023 | |
| Diabetic Management (patient not having symptoms) | -Trouble with Continuous Glucose Monitor (CGM) -My Dexcom/Freestyle Libre sensor isn't working -My sensor isn't transmitting, my sensor fell off. -I need help with my insulin pump. | No | N/A | Create detailed patient case regarding issues or medication question. Determine in Athena which provider ordered the medication/device in question and send urgent patient case to ordering provider staff box. | ||
| Imaging Facility or External Lab Request | -3rd party caller asking for a verbal order -To verify order -Order needing approval -Needs to speak with clinical staff about an order | Yes | WARM TRANSFER | Keep caller on line and warm transfer to appropriate clinic nurse extension. IF no answer, warm transfer to triage nurse extension. | Triage Extension: 2024 Jefferson:2021 Harkle:2022 Galisteo:2023 | |
| Patient Calling to ask if fasting is required for upcoming blood work | -Do I need to fast for my bloodwork? | No | N/A | Advise patient that for accurate information please contact the lab directly (i.e. Quest, Tricore). The public can access the Quest Test Directory online at testdirectory.questdiagnostics.com or call Quest at 1-800-697-8378. The public can access the Tricore Test Directory at www.tricore.org and select Test Directory from Menu. | ||
| Provider to Provider Calls | -I am a provider at *external facility* I need to speak SCC provider | Yes | WARM TRANSFER | Keep caller on the line and warm transfer to appropriate clinic nurse extension. -IF no answer after one minute of ringing, send a patient case, marked as urgent, to the provider's staff inbox, please include all relevant information: including the caller's location, the provider's name, the reason for the call, and the best callback number. | Jefferson:2021 Harkle:2022 Galisteo:2023 | |
| Pharmacy - Wants to talk to Southwest Care Center Pharmacy | -I want to talk to Alameda, Jefferson, Harkle Pharmacy, -Can you connect me to the pharmacy -Can I talk to the pharmacist | Yes | COLD TRANSFER | Determine which Southwest Care Center pharmacy location the caller needs and cold transfer to appropriate pharmacy: -Alameda Pharmacy Extension: 3004 -Harkle Pharmacy Extension: 3003 -Jefferson Pharmacy Extension: 5005 | ||
| Pharmacy- Patient is calling wanting to transfer to SCC pharmacy | I want change to SCC pharmacy | Yes | COLD TRANSFER | Determine which Southwest Care Center pharmacy location the caller needs and cold transfer to appropriate pharmacy: -Alameda Pharmacy Extension: 3004 -Harkle Pharmacy Extension: 3003 -Jefferson Pharmacy Extension: 5005 | ||
| Clinic Operations | ||||||
| Upset Patient, Patient Dissatisfaction, Complaint, Grievance | -I want to speak with a manager -I am upset -I am not happy -I have a complaint about a clinic/SCC staff member/SCC. | Yes | WARM TRANSFER | The call center agent will determine the department related to the caller's dissatisfaction and will use the Call Extension List to attempt a warm transfer to clinic manager. If there is no answer, the agent will instruct the caller to leave a detailed voicemail on the transfer line and notify them that they will receive a callback within 24 hours. Please follow document 'Southwest Care Center process for patient complaints and request to speak to executive leadership'. Enter into Compliatrics as patient complaint using link. | Jefferson- Jack Allison: 1004 Harkle- Courtney Cameron:1020 Galisteo- Anna Haubrich: 1445 | |
| Compliance or Risk wants to file and FORMAL complaint or grievance | -I want to file a formal complaint against -I want to place a formal grievance -I don't want to talk to the clinic or department manager -I want to go higher -This is a civil rights issue | Yes | COLD TRANSFER | Encourage them to submit an incident report using the company website or email compliance@southwestcare.org and ensure patient this will make sure the complaint goes to the compliance and risk department; If patient refuses to do this cold transfer them to Compliance Officer Helen Dwight ext 1544. | Helen Dwight: 1544 | |
| Risk OR Legal Notification of Lawsuit Requesting information on a lawsuit Reporting to the DOH (Dept. of Health) | -Sue you -Lawsuit -Lawyers -Complaint of license -I will be calling the DOH | Yes | COLD TRANSFER | Inform caller that all requests or information relating to legal, board, or department of health matters need to be submitted via email to compliance@southwestcare.org with their contact information and details of their request; if they refuse cold transfer them to the Complaince Officer Helen Dwight @ ext 1544. | Helen Dwight: 1544 | |
| Patient Returning Phone Call from SCC Staff Member | -"I missed a phone call." -"I'm returning a phone call." -"Someone called me but I don't know who." | Yes/No | WARM TRANSFER | Confirm if patient is: ACTIVE (meaning they have been seen by their SCC PCP within 2 years) or INACTIVE (meaning it has been more than 2 years since last PCP visit) -If INACTIVE: Should be treated as a New Patient; refer to New Patient / Returning Inactive Patients Checklist. -If ACTIVE: Review patient chart for applicable patient case, take appropriate action as directed by SCC staff in the patient case. If nursing was attempting to get ahold of the patient, warm transfer to the appropriate clinic nursing extension (Jefferson / Harkle / Alameda RN extension). | Contact List | |
| Deceased Patient Notification (Funeral Home or Family Caller) | -"I am calling to inform you that the patient has passed away." Note: This could be a family member, case manager, or another entity, or a funeral home calling to request for provider involvement. | No | N/A | Create detailed patient case please include who called, details of information needed or provided during call, mark as urgent and send to assigned usual provider. | ||
| Case Manager Assistance | -Ryan White -Housing assistance -Assist with paying bill (electricity or utilities) -Assist with HIV medications -Financial assistance -Insurance assistance -Copay assistance -Debit card -Food pantry -I need to confirm that my check is ready at the clinic. | Yes | WARM TRANSFER | Identify assigned Case Manager (Case Manager or Primary Care Patient Navigator) in Athena Care Team Drop Down. -If Case Manager OR Primary Care Patient Navigator is listed, attempt warm transfer. -If no case manager is listed, send patient case to the appropriate clinic patient navigator Athena box. Inform caller that case manager will respond within 3 business days. | Contact List | |
| Patient Calling for Paperwork/Check is ready for pick up at clinic front desk | -I want to see if my rent check is ready at the front desk -I want to confirm if my paperwork is ready at the front desk | Yes | WARM TRANSFER | -Warm Transfer to appropriate clinic front desk extension. | Jefferson: 3107 Harkle: 3106 Galisteo: 3102 | |
| Patient Having Problem with Portal | Issue accessing patient portal, viewing or finding documents | Yes | WARM TRANSFER | Call center agent will attempt to assist patient navigate portal access. If call center agent is unable to help patient, create a patient case in Athena and send to appropriate patient navigator Athena box. | ptnavigatorharkle ptnavigatoralameda ptnavigatorjefferson | |
| Patients Calling Wanting Information About SCC Sliding Scale | I want to renew my sliding scale, how can I apply for your clinic discount/sliding scale. | No | N/A | Look for existing patient case. If an existing patient case is found, update and route to appropriate patient navigator Athena box. If no existing patient case is found, create a new patient case and send to appropriate patient navigator Athena box. | ptnavigatorharkle ptnavigatoralameda ptnavigatorjefferson | |
| Onsite Quest Labs | -Is lab open today -What are lab hours of operation -Is lab tech there | No | N/A | Provide appropriate information about specific location's lab coverage for the day in question. | ||
| Patient Requesting to be Inactivated (no longer wants to be an SCC patient) | -I have transferred my care to another organization, -I do not want to be an SCC patient anymore | No | N/A | If the patient is not complaining and simply states they found another provider or have moved out of state, send a brief patient case noting that the patient called today to request to be inactivated to the appropriate clinic manager Athena box. If the patient shares dissatisfaction about SCC services, place an official SCC incident report with details about the patient's complaint / why the patient is dissatisfied and leaving the organization. | ||
| Patient Requesting a change in frequency of phone calls, text messages and other forms of communication from SCC. | -SCC is calling/texting me too often -I want to be removed from your call list | No | N/A | Open the patient's communication preferences in Quickview -> Manage Privacy -> Communicator Automated Messaging Preferences and then uncheck according to patient request. | ||
| Vendors | -Pharmaceutical or Drug Representative -Cleaning services -Mathison -Bio Medical Equipment Services -Quest lab supervisors -Sales call | Yes | COLD TRANSFER | If caller is not requesting to speak with a specific person, cold transfer to appropriate clinic manager. Instruct caller to leave detailed voicemail if no answer. | Jefferson- Jack Allison: 1004 Harkle- Courtney Cameron:1020 Galisteo- Anna Haubrich: 1445 | |
| Departments | ||||||
| HIM (Health Information Management) | -Medical Records request -I need my chart, release of information, health history, past medical history | Yes | COLD TRANSFER | Cold transfer to Extension 2005, inform caller of HIM general email box that is constantly monitored for HIM requests (HIM@southwestcare.org). If no answer, instruct caller to leave detailed voicemail or send detailed email to HIM@southwestcare.org. | Medical Records: 2005 | |
| Children, Youth & Family Department or Adult Protective Services or other enforcement agency call | -Gathering information -Following up on an active case or complaint -Calling to discuss a case with [provider name] | Yes | WARM TRANSFER | If provider being requested is listed on the call extension list, warm transfer to appropriate provider. If provider not listed, transfer to appropriate clinic manager. Inform caller to leave voicemail with callback details if no answer. | Jefferson- Jack Allison: 1004 Harkle- Courtney Cameron:1020 Galisteo- Anna Haubrich: 1445 | |
| Medical Staff Office | -Credentialing and provider licensure (Medical Board, Board of Osteopathic Physicians, Board of Nursing, Board of Pharmacy, etc.) -Regulatory licensing boards needing to speak with the Medical Staff Office at SCC regarding provider licensure) -Provider insurance coverage, privileging (The Process of authorizing a licensed or certified practitioners specific scope of practice and patient care services delivery. This is performed in conjunction with ongoing evaluation of individual clinical qualifications and/or performance) | Yes | COLD TRANSFER | Cold transfer to Dr. Kevin Lopez, Chief Medical Officer, CMO, Extension 1208, instruct caller that if no answer to please leave detailed message with contact information | Dr. Kevin Lopez: 1208 | |
| Prevention and Community Outreach | -Syringe exchange -Rapid testing -Outreach -Needle exchange | Yes | WARM/COLD TRANSFER | Attempt warm handoff to Prevention and Outreach Specialist cell phone 505-490-1147. IF NO ANSWER, instruct caller to leave voicemail and their call will be returned in 24 hours. See Call Extension List. | Outreach Team: 505-490-1147 | Applies to Santa Fe ONLY (Harkle and Alameda) for Syringe Services; Currently no Syringe Services at Jefferson |
| Social Services HOPWA (Housing Opportunities for Persons with AIDS) | Yes | WARM/COLD TR ANSFER | Attempt warm transfer to HOPWA (Housing Opportunities for Persons with AIDS. This is a specific housing program SCC administers on behalf of New Mexico Mortgage Finance Authority to assist low-income individuals (and their families) who have a medical diagnosis of HIV. The patients enrolled in this program will refer to it specifically as "HOPWA.") Program Manager Extension 1532. IF NO ANSWER after 30 seconds, instruct caller to leave detailed voicemail, cold transfer to Extension 1532 | HOPWA Program Manager: 1532 | This is a specific housing program SCC administers on behalf of New Mexico Mortgage Finance Authority to assist low-income individuals (and their families) who have a medical diagnosis of HIV. The patients enrolled in this program will refer to it specifically as "HOPWA.") Generic housing assistance requests should be handled by Case Manager. | |
| Human Resources - General Inquiries | -Employment Verification -Income Verification, -Candidate Resume Inquiry -Third-Party Vendor -Recruiters -Former Employee -Candidates | Other | N/A | Inform caller that all HR requests are accepted by email at the following address hr@southwestcare.org. | ||
| Human Resources - Specific Callers (Concentra and ALL State or Federal Agencies) | Specific Contacts: -Concentra and ALL NM State or Federal Agencies (EEO, Department of Workforce Solutions, other Department of States of New Mexico or United States Departments) | Yes/Other | COLD TRANSFER | Cold transfer to Extension 1427, inform caller that someone will return call and inform caller that they can get priority assistance by emailing hr@southwestcare.org and providing detailed message. | HR: 1427 | |
| Prospective Provider looking for a place to do clinicals | -Doctor -Physician | No | N/A | Please send email to Anna Anon- aannon@southwestcare.org | ||
| Medical assistant/ Nurses calling for a place to do clinicals | -Medical assistants -Nurses | No | N/A | Advise caller that clinical rotation accommodation is based off each clinic "current capacity". Please open a compliatric incident report under - Informational/Guidance. When completing the form please make sure to collect the students, full name, phone number, email, College/University/Program. Advise caller that an SCC Team Member will reach out to discuss further. | ||
| Quality, questions about quality or population health or selling quality or population health products | -Quality -Population health -Quality measure(s), care gap(s) -Annual wellness visits -Value-based, value-based care | Other | N/A | Provide email for Tori Navaiz population health lead CHW. vnarvaiz@southwestcare.org | ||
| Revenue Cycle | -Question about patient bill or invoice -Billing concerns -Insurance benefit questions, explanation of benefits | Yes | WARM TRANSFER | Cold transfer to Extension 2289, inform caller of billing general email box that is constantly monitored for billing questions and concerns (sccbilling@southwestcare.org). If no answer, instruct caller to leave detailed voicemail or send detailed email to Billing@southwestcare.org. | Billing: 2289 | |
| Quest Billing Questions | -Question about Quest bill -Recieved Quest Bill in mail -Need help understanding Quest bill | No | N/A | Please instruct caller/patient to contact their insurance to discuss or appeal a bill from Quest Diagnostics. Quest is a third-party entity and SCC billing department cannot help with any questions. | ||
| Finance | -Business Office -Accounts Receivable -Accounts Payable/AP -Non-Patient Invoices -Business Payments -Speak to a Finance Team Member -W9, 1099, W2 -Accounting | Other | N/A | Inform caller of email address for quickest response ap@southwestcare.org | ||
| Facilities | -Any requests associated with maintenance or facilities. | Other | N/A | Inform caller that all related inquires should be sent to the email address of Facilities Director at demerson@southwestcare.org. | ||
| Information Technology | Vendor for IT systems, error for website | Other | N/A | Inform caller of email address for quickest response support@southwestcare.org | ||
Clinical Informatics | Athena, Outside Vendors | Other | N/A | Inform caller of email address for quickest response jwesterfield@southwestcare.org |
📞 Callback Guidelines
When a patient requests a call back, remind them of the expected timeframes:
| Call Type: | Callback Timeframe |
|---|---|
| Urgent Calls | As soon as possible, or within 24 business hours |
| Patient Case Callbacks | As soon as possible or within 72 business hours |
| Upset Patient (Transferred to Clinic Manager) | As soon as possible, or within 24 business hours |
📝Patient Case Documentation Tips
When creating a patient case, include detailed and relevant information. Be sure to document the following:
Reason for the patient’s call
What the patient is requesting
Duration of symptoms (if applicable)
Medications the patient is currently taking (if applicable)
Whether the patient would like a telehealth appointment
If and when the patient was exposed to any illness or disease
Confirm all phone numbers and fax numbers
Confirm spelling of names, facilities, and offices