Overview
The enrollment workflow guides operations team members through the complete process of enrolling new patients into the AllCare platform. This includes gathering information, verifying eligibility, creating records, and coordinating care setup.Processing Time: Standard enrollments are processed within 24-48 hours. Urgent enrollments can be expedited with manager approval.
Enrollment Process Overview
1
Receive Enrollment Request
Request arrives via Freshdesk, facility portal, or referral
2
Gather Patient Information
Collect all required demographics and insurance data
3
Verify Eligibility
Check insurance eligibility and coverage
4
Create Patient Record
Enter patient into AllCare.ai and ECW
5
Assign Provider
Link patient to appropriate primary provider
6
Setup Medications
Import or enter medication list
7
Schedule Initial Visit
Coordinate first provider visit
8
Confirm Enrollment
Notify facility and close ticket
Step 1: Receive Enrollment Request
Request Sources
| Source | Priority | SLA |
|---|---|---|
| Freshdesk Ticket | Standard | 24-48 hours |
| Facility Portal | Standard | 24-48 hours |
| Phone Request | Varies | Based on urgency |
| Provider Referral | High | 24 hours |
| Hospital Discharge | Urgent | Same day |
Required Information Checklist
Before proceeding, verify you have:Missing Information
If information is missing:- Check if facility can provide immediately
- Request via ticket reply or phone
- Note what’s missing in the ticket
- Proceed with available info if urgent
Step 2: Gather Patient Information
Demographics
| Field | Required | Notes |
|---|---|---|
| Full Legal Name | ✓ | As on insurance card |
| Date of Birth | ✓ | MM/DD/YYYY format |
| SSN | ✓ | Full or last 4 |
| Gender | ✓ | Legal/assigned |
| Primary Language | ○ | Default: English |
| Address | ✓ | Current residence |
| Phone Number | ○ | If available |
| ○ | If available |
Insurance Information
| Field | Required | Notes |
|---|---|---|
| Primary Insurance | ✓ | Name, ID, group |
| Member ID | ✓ | From insurance card |
| Group Number | ○ | If applicable |
| Effective Date | ✓ | Coverage start |
| Secondary Insurance | ○ | If applicable |
| Medi-Cal BIC/CIN | ✓* | *If Medi-Cal patient |
| Medicare Number | ✓* | *If Medicare patient |
Clinical Information
| Field | Required | Notes |
|---|---|---|
| Primary Diagnosis | ✓ | ICD-10 if available |
| Chronic Conditions | ✓ | List all known |
| Allergies | ✓ | Medications and other |
| Current Medications | ✓ | With dosages |
| DNR Status | ○ | If known |
| Mobility Status | ○ | Ambulatory, wheelchair, etc. |
Step 3: Verify Eligibility
Medi-Cal Verification
1
Access DHCS Portal
Log into the Medi-Cal eligibility system
2
Search Patient
Enter patient SSN or BIC number
3
Verify Coverage
Check:
- Active coverage dates
- Aid code
- Share of Cost (SOC)
- Managed care plan
4
Document Results
Screenshot or note eligibility details in ticket
Medicare Verification
1
Access Noridian Portal
Log into Medicare eligibility system
2
Search Patient
Enter Medicare Beneficiary Identifier (MBI)
3
Verify Coverage
Check:
- Part A effective date
- Part B effective date
- Medicare Advantage plan (if any)
- Current benefit period
4
Document Results
Note eligibility details in ticket
Eligibility Issues
Coverage inactive
Coverage inactive
Contact facility to verify insurance information. May need updated card or different insurance.
Share of Cost not met
Share of Cost not met
Wrong plan/network
Wrong plan/network
Verify we are in network for patient’s plan. Escalate to manager if out of network.
Pending Medi-Cal
Pending Medi-Cal
Can proceed with enrollment, note pending status. Follow up on eligibility.
Step 4: Create Patient Record
AllCare.ai Entry
1
Navigate to Patients
Go to Patients → Add New Patient
2
Select Facility
Choose the patient’s facility from dropdown
3
Enter Demographics
Fill in all patient information:
- Name, DOB, SSN
- Contact information
- Emergency contacts
4
Add Insurance
Enter primary and secondary insurance details
5
Add Clinical Info
Enter diagnoses, allergies, and conditions
6
Save Patient
Click Save to create the record
7
Note Patient ID
Record the AllCare patient ID for reference
ECW Entry
1
Open ECW
Access eClinicalWorks
2
Add Patient
Go to Patient → Add New
3
Enter Information
Enter matching demographics:
- Ensure name/DOB matches AllCare exactly
- Add insurance information
4
Link Records
Note ECW patient ID in AllCare record (if not auto-linked)
Data Accuracy
Double-check:- Name spelling (including suffixes: Jr., Sr., III)
- Date of birth format
- Insurance member ID
Step 5: Assign Provider
Provider Assignment
1
Identify Facility Provider
Check which provider is assigned to the patient’s facility
2
Verify Availability
Confirm provider has capacity for new patient
3
Assign in AllCare
Go to patient profile → Care Team → Add Provider
4
Assign in ECW
Set primary care provider in ECW patient record
Special Considerations
| Situation | Action |
|---|---|
| Patient needs specialist | Add specialty provider to care team |
| No provider at facility | Escalate to provider coordination |
| Provider at capacity | Discuss with manager for assignment |
| Patient requests specific provider | Accommodate if possible |
Step 6: Setup Medications
Medication Entry
1
Gather Medication List
Use provided med list, face sheet, or PioneerRx lookup
2
Enter in ECW
Add all current medications with:
- Drug name and strength
- Dosage and frequency
- Prescribing doctor
- Start date
3
Verify Allergies
Confirm drug allergies are entered
4
Flag Controlled Substances
Note any controlled medications for provider review
Pharmacy Coordination
- Verify patient’s pharmacy (usually AllCare Pharmacy)
- Confirm medications are in PioneerRx if existing patient
- Set up delivery schedule with facility
Step 7: Schedule Initial Visit
First Visit Scheduling
1
Determine Visit Need
- New patient comprehensive visit
- Urgent clinical need
- Medication reconciliation
2
Check Provider Availability
Review provider schedule for the facility
3
Schedule Visit
Create visit in AllCare.ai with:
- Visit type: New Patient
- Date and time
- Provider assigned
- Notes on clinical priorities
4
Notify Facility
Confirm visit date/time with facility
Visit Timing Guidelines
| Situation | Initial Visit Target |
|---|---|
| Routine enrollment | Within 7 days |
| Hospital discharge | Within 48-72 hours |
| Urgent clinical need | Within 24 hours |
| Stable, medications only | Within 14 days |
Step 8: Confirm Enrollment
Completion Checklist
Before closing enrollment:Facility Notification
Send confirmation to facility including:- Patient successfully enrolled
- Assigned provider name
- Initial visit date/time
- Pharmacy information
- Contact for questions
Ticket Closure
- Update ticket with enrollment summary
- Attach any relevant documents
- Set status to Resolved
- Select appropriate resolution category
Special Enrollment Scenarios
Hospital Discharge Enrollment
1
Expedite Processing
Prioritize for same-day enrollment
2
Get Discharge Summary
Request hospital discharge documents
3
Reconcile Medications
Compare hospital meds to prior list
4
Schedule Transition Visit
Arrange provider visit within 48-72 hours
5
Coordinate Equipment
Arrange any DME or supplies needed
Pending Insurance Enrollment
1
Create Record
Enter patient with “Pending” insurance status
2
Document Application
Note Medi-Cal or insurance application status
3
Set Follow-Up
Create task to check eligibility in 30 days
4
Notify Facility
Inform facility of pending status
Dual-Eligible Patients
Patients with both Medicare and Medi-Cal:- Verify both coverages
- Enter both insurance records
- Note coordination of benefits order
- Check for Cal MediConnect or other special programs
Troubleshooting
Duplicate patient found
Duplicate patient found
Check if existing record matches:
- If yes, update existing record
- If different person, proceed with new record
- Document duplicate check in ticket
Insurance won't verify
Insurance won't verify
- Confirm member ID is correct
- Check if coverage is future-dated
- Try alternative verification method
- Contact insurance directly if needed
Provider unavailable for facility
Provider unavailable for facility
Medications unclear
Medications unclear
- Request face sheet from facility
- Check PioneerRx for prescription history
- Schedule provider for medication reconciliation