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Overview

This workflow covers patient enrollment when a new patient is referred to AllCare. Key Goals:
  • Ensure complete referral information
  • Create consistent, matching patient records in ECW and AllCare.ai
  • Capture and verify insurance details
  • Verify cross-system search functionality

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Quick Reference

SLA: Complete enrollment within 24 hours of referral receipt
Systems: ECW, AllCare.ai, Freshdesk, DHCS/Noridian (insurance verification)

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Workflow Diagram

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Step-by-Step Procedure

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1. Receive and Verify Referral

In Freshdesk:
  • Confirm referral or intake form received via Freshdesk or secure email
  • Open or create ticket for enrollment
Verify Required Information:
  • ✓ Full legal name (first, middle, last)
  • ✓ Date of birth
  • ✓ Social Security Number (if available)
  • ✓ Facility name and unit/room number
  • ✓ Primary contact information
  • ✓ Insurance information (if available)
If Information Missing:
  • Contact referral source (facility, hospital, family)
  • Request missing details
  • Document in Freshdesk: “Awaiting [specific information] from [source]”
  • Set reminder to follow up

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2. Create Patient in ECW

Open ECW:
  • Navigate to Patients → New Patient
Enter Demographics: Required Fields:
  • Full Name: Enter exactly as it appears on legal documents
    • First name
    • Middle name (if available)
    • Last name
    • Suffix (Jr., Sr., III, etc.)
  • Date of Birth: Use consistent format (MM/DD/YYYY)
  • Social Security Number: Enter if available (required for insurance billing)
  • Sex: As documented
  • Facility Information:
    • Facility name (select from dropdown)
    • Unit/wing
    • Room number
    • Bed assignment (if applicable)
Contact Information:
  • Primary phone number
  • Emergency contact name and phone
  • Email address (if available)
Address:
  • Use facility address for patients residing in facility
  • Document home address if patient is home-based

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3. Add Insurance Information (if available)

In ECW Insurance Tab:
  • Click Add Coverage
Enter Insurance Details:
  • Payer Name: Select from dropdown or search
  • Policy Number: From insurance card
  • Group Number: From insurance card
  • Effective Date: Coverage start date
  • Termination Date: Coverage end date (if known)
  • Relationship to Insured: Self, spouse, child, etc.
  • Insured Person Information: If patient is dependent
Upload Insurance Card Images:
  • Front of card (PDF or photo)
  • Back of card (PDF or photo)
  • Ensure images are clear and readable
Verify Eligibility:
  • Click Verify Eligibility in ECW
  • Check additional portals:
    • DHCS (for Medi-Cal/Medicaid)
    • Noridian (for Medicare)
    • Payer-specific portal if available
Document Verification Result:
  • ✓ Verified: Coverage active, note effective dates
  • ✗ Failed: Document reason (inactive, wrong policy number, etc.)
  • ⏳ Pending: Verification in progress, set follow-up
If Verification Fails:
  • Document failure reason in notes
  • Flag for follow-up with facility or family
  • Proceed with enrollment (can update insurance later)

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4. Save Patient in ECW

Review All Information:
  • Double-check name spelling
  • Verify DOB is correct
  • Confirm facility and room assignment
  • Review insurance details
Save Patient Record:
  • Click Save to create patient in ECW
  • Note the MRN (Medical Record Number) assigned by ECW
  • Write down or copy MRN for AllCare.ai enrollment

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5. Create Matching Patient in AllCare.ai

Open AllCare.ai:
  • Navigate to Patients → New Patient
Enter IDENTICAL Information: Critical: Match ECW Exactly
  • Name: Use EXACT same spelling and format as ECW
  • DOB: Use SAME date format as entered in ECW
  • Facility: Select same facility from dropdown
  • Room/Unit: Enter same room number
Why This Matters:
  • Prevents duplicate patient records
  • Ensures systems can cross-reference
  • Enables proper data synchronization
Add Insurance (if entered in ECW):
  • Add insurance policy number to AllCare.ai patient profile
  • Match payer name to ECW entry
  • Document verification status
Save Patient in AllCare.ai:
  • Click Save to create patient record
  • Note the AllCare.ai Patient ID

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6. Verify Cross-System Functionality

Test Search in Both Systems: In ECW:
  • Search for patient by name
  • Search for patient by DOB
  • Verify patient appears in search results
In AllCare.ai:
  • Search for patient by name
  • Search for patient by DOB
  • Verify patient appears in search results
If Patient Not Found:
  • Check for spelling differences
  • Verify DOB format matches
  • Check for special characters or spaces
  • Correct any discrepancies and re-save

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7. Document and Close

In Freshdesk:
  • Update ticket with enrollment details:
    • “Patient enrolled successfully”
    • “ECW MRN: [number]”
    • “AllCare.ai Patient ID: [number]”
    • “Insurance: [Verified/Pending/None]”
  • Attach referral documents if not already attached
  • Change ticket status to Resolved
In AllCare.ai:
  • Add note: “Patient enrolled [date], ECW MRN: [number]”
  • Document any pending items (e.g., insurance verification)

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Data Requirements

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Required for Enrollment

  • Full legal name
  • Date of birth
  • Facility and room assignment
  • Social Security Number (required for insurance billing)
  • Primary contact phone number
  • Emergency contact information

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Optional but Helpful

  • Insurance information
  • Email address
  • Home address (if applicable)
  • Medical history summary

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Best Practices

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Name Matching

  • Use full legal names, not nicknames
  • Include middle names when available
  • Match capitalization between systems
  • Be consistent with suffixes (Jr., Sr., III)

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Date Format Consistency

  • Use same date format in both systems
  • Verify month/day/year order
  • Double-check for typos (01/02/1950 vs 01/20/1950)

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Insurance Documentation

  • Always upload card images when available
  • Document verification attempts even if failed
  • Note specific error messages from verification systems
  • Set follow-up reminders for pending verifications

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Quality Checks

  • Search for patient immediately after creation
  • Verify patient appears in both systems
  • Confirm facility assignment is correct
  • Check for potential duplicate records

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Troubleshooting

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Issue: Patient not found in search after creation

Solution:
  • Verify spelling matches exactly between systems
  • Check for extra spaces or special characters
  • Confirm DOB format is consistent
  • Try searching by facility and room number
  • If still not found, contact system support

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Issue: Insurance verification fails

Solution:
  • Verify policy and group numbers are correct
  • Check effective dates (coverage may not be active yet)
  • Try alternate verification portals (DHCS, Noridian)
  • Contact insurance company directly if needed
  • Document failure and proceed with enrollment
  • Flag for follow-up when more information available

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Issue: Duplicate patient records suspected

Solution:
  • Search thoroughly before creating new record
  • Check variations of name (maiden name, nickname)
  • Search by DOB and facility
  • If duplicate found, use existing record
  • If duplicate created accidentally, contact system admin to merge

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Issue: Referral information incomplete

Solution:
  • Contact referral source for missing information
  • Document what information is missing
  • Create patient with available information
  • Flag record as “incomplete - pending [specific info]”
  • Set reminder to follow up
  • Update record when information received

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