The Case Management module provides Epic workflows for case managers and related roles that are responsible for insurance authorization/certification, case management, quality review, and discharge planning. Case managers rely on many of the same clinical tools, such as flowsheets, notes, and patient history, as other clinicians, but they also have a unique set of workflows including utilization review, payor communication, and discharge placement.

Resources

The following resources provide information on Case Management functionality.

General Resources

  • Accessing HCBAP Account Notes - (Handout) Social workers with the Case Management security may access HCBAP social work account notes through the patient’s encounter via Patient Station, Patient Lists (for the current encounter), or Hospital Account Maintenance.
  • Adding a New Level of Care Order - (Handout) When Indicia recommends a different Level of Care than the one specified in the provider’s Admission Bed Request order, Nurse Navigators (and others managing these situations) should follow this workflow to place a new LOC order.
  • Discharge Delays & Milestones- (Handout) Discharge Milestones are key activities or tasks that must be completed prior to discharge. Discharge Delays identify reasons patients are not discharged by 1100 on the day of discharge.
  • Expected Discharge Date - (Handout) The Expected Discharge Date (EDD) and Time in Epic has strong multidisciplinary value towards throughput workflows within the organization, to meet regulatory compliances, and overall efficient discharge processes.
  • Level of Care (LOC) Definitions - (External Link)

Auth/Cert Records

  • Documenting Auth/Cert and Bed Days Information for Utilization Management - (Handout) Utilization Management nurses create Auth/Cert records in Epic to document information related to obtaining precertification for inpatient admissions. The Bed Days form is used to document Approved Days, Denied Days, and the Next Review Date.
  • Entering a Note for Utilization Management - (Handout) Utilization Management nurses and clerks use Notes to document activity related to a particular encounter. Each Note Type has its own associated SmartText, which auto-populates the Note once the Type is selected.
  • Using the UIHC PFS Requested LOC Review Workqueue - (Handout) When a patient class requires review by Level of Care nurses, pre-authorization staff will flag the patient’s Auth/Cert for review by LOC. This flag will send the Auth/Cert to the UIHC PFS Requested LOC Review Workqueue [683582].

Facility/Agency Referrals

  • CCM CareLink Conversations Report - (Handout) Case managers can view Service Requests messages from CareLink facilities from within the CCM CareLink Conversations report. Messages display as conversations and may be replied to directly from within the report.
  • CCM CareLink Message Notifications - (Handout) Case managers may be notified of new Service Request messages from CareLink facilities through the Patient Lists activity. Additionally, case managers who are a part of the patient’s Treatment Team and are a part of the Case Management In Basket pool will receive an Outlook email notification of a new Service Request message.
  • Facility/Agency Referral Report Contents - (Handout) This document contains a list of Epic Notes, by note title and content, that are used in the Case Management module by Social Workers and Nurse Navigators. 
  • Internal/External Communication Guide for Case Managers - (Handout) There are many methods of communicating to others using the Case Management Module. Use this table to determine the appropriate location for your comments and messages, both internal and external.
  • Printing a Facility/Agency List for a Patient - (Handout) Case Managers may need to provide a list of possible placement facilities/agencies to the patient so that they may choose where to go following their discharge. A list may be printed from the Case Management navigator, the Summary Sidebar report, or from the Patient Encounter Summary activity.
  • Searching the Facility/Agency Database - (Handout) The Facility/Agency Database includes a listing of facilities and agencies to which a patient may be referred following discharge. Searching for facilities/agencies occurs within the appropriate continuing care coordination sections within the Case Management navigator.
  • Sending & Documenting Facility/Agency Referrals - Quick Start Guide - (Handout) Referrals to facilities/agencies for a patient will be documented within the Case Management navigator using the coordination sections (e.g. Destination). This is where the initial report will be sent and where the referral status will be documented.
  • Sending Supplemental Documentation to Post-Discharge Referral Facilities/Agencies - (Handout) Once the post-discharge referral has been documented in Epic and the initial report has been sent, facilities/agencies may request additional patient documentation. This supplemental documentation may be sent via Chart Review using the Route option.
  • Viewing Facility/Agency Referral Information - (Handout) Post-discharge placement and referral information may be viewed in many places within Epic, including the After Visit Summary, Case Management Overview & Placement History reports, Patient Lists, and Notes.

Payor Communication

  • Adding a Recipient and Using the Payor Communication Directory - (Handout) Payor Comm is used by Utilization Management nurses and clerks to fax reports, clinical notes and other information to insurance companies. The Payor Comm activity is linked to a customized Payor Communication Directory, which stores payor contact information (phone, fax, contact name) and provides easy access for users. A history of all communications sent to payors will display in the Payor Comm activity window.
  • Sending a Standard Report and Using Document Builder - (Handout) Payor Comm is used by Utilization Management nurses and clerks to fax reports, clinical notes and other information to insurance companies. Users can send a standard report, as well as customized reports and documents. A history of all communications sent to a payor will display in the Payor Comm activity.

Psych-Specific Resources

  • Adding a Provider on the Fly - (Handout) The Provider on the Fly activity allows users to create a provider record when it does not currently exist in the system.
  • Entering Follow-Up Providers for Psychiatric Patients - (Handout) Social Workers will be able to document Follow-Up Providers in a navigator section which will populate for all patients admitted to 1JP, 2JP, or 3BT. This follow-up information will also populate the SW Discharge Planning Note, LIP’s Discharge Summary, and be mailed/routed to the desired follow-up providers after discharge to meet PSY Transition Record Core Measure requirements.

Utilization Review

  • Using Utilization Review and Accessing Indicia - (Handout) Utilization Review allows users to document and review Level of Care and Length of Stay information using Indicia. In some cases, reviews may also be completed manually using Utilization Review.

Related Resources

  • Indicia Job Aids - (Handout) Accessing job aids on the Indicia website.
  • UI CareLink Admission Coordinators Placement Requests - (Handout) UI CareLink Admission Coordinators can receive placement requests electronically via Service Request In Basket messages. Coordinators will be able to review the request and Accept or Decline the request for service. Additionally, coordinators will be able to communicate directly to the sender of the Service Request message to answer questions, obtain clarification and/or request additional information.

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