POLICIES AND PROCEDURES Policy #: 401-1512 Lead Department: Quality Improvement Title: Missed Appointment and Patient Recall Original Date: 02/01/1996 Last Revision Date: 08/05/2013 Approved by: Clinical Quality Improvement Work Group (CQIW) Effective Date: 08/05/2013 Purpose: To describe procedures used by Primary Care Providers (PCPs) to follow-up on members‘ missed appointments. Policy: Central California Alliance for Health (the Alliance) assists Primary Care Providers (PCPs) in encouraging members to keep scheduled appointments, and follow-up with members for missed appointments. If appointments are missed, the PCP may use member follow-up procedures. Definitions: Procedures: 1. If a member fails to keep an appointment, the PCP is notified by the office staff by the end of the day to review the chart to determine if another visit is medically necessary. 2. If the PCP determines the visit is still medically necessary, the chart is forwarded to office staff to telephone the member the following day and advise that follow-up care is needed. 3. If a second appointment is made and the member fails to keep this appointment, the physician should repeat this process. 4. If a third appointment is missed, the physician’s office may complete an Alliance Member Appointment No-Show form through their web portal or by printing out a hard copy from the Alliance web site. 5. On a weekly basis, the Member Services Program Specialist generates a mail merge report which is used to send letters to members for whom the Alliance has received missed appointment follow up forms. The letter outlines the reasons why it is important for the member to keep his/her medical appointments or to cancel if the appointment is no longer needed. 6. A call note will be generated in the member record in AIS, with missed appointment as the call reason. 7. When speaking with a member, the MSR can use the information noted in AIS about the member’s missed appointments to provide member education on the importance of Page 1 of 3 POLICIES AND PROCEDURES Policy #: 401-1512 Lead Department: Quality Improvement Title: Missed Appointment and Patient Recall Original Date: 02/01/1996 Last Revision Date: 08/05/2013 Approved by: Clinical Quality Improvement Work Group (CQIW) Effective Date: 08/05/2013 keeping scheduled appointments, canceling in advance if they are unable to keep the appointment, and the possibility of being reassigned if three or more appointments are missed within 12 months as described in Policy 300-6050 Provider Request to Reassign Member and Policy 200-4004 Missed Appointment Follow-Up. 8. The MS Supervisors will also use this information as documentation when processing a reassignment request based on missed appointments. 9. All attempts to contact the member and the member’s responses are required to be documented in member’s medical record. 10. The process is monitored by the Quality Improvement Nurses during Facility Site Reviews. References: Alliance Policies: 200-4004 Missed Appointment Follow-Up 300-6050 Provider Request to Reassign Member Regulatory: Contractual: Medi-Cal State Contract 08-85216 Legislative: MMCD Policy Letter: PL 02-002 Site Review Supersedes: Other: Attachment A – Member Letter Lines of Business This Policy Applies To: Medi-Cal Healthy Families Healthy Kids Santa Cruz Alliance Care IHSS Revision History: Review Date Revised Date Access for Infants and Mothers Individual Conversion Plan Santa Cruz County LIHP Program Monterey County LIHP Program Changes Made By Page 2 of 3 Approved By POLICIES AND PROCEDURES Policy #: 401-1512 Lead Department: Quality Improvement Title: Missed Appointment and Patient Recall Original Date: 02/01/1996 Last Revision Date: 08/05/2013 Approved by: Clinical Quality Improvement Work Group (CQIW) Effective Date: 08/05/2013 07/01/1998 12/01/2000 12/01/ 2002 07/01/2006 03/01/2010 03/01/2012 02/06/2013 07/01/1998 12/01/2000 12/01/ 2002 07/01/2006 03/01/2010 03/01/2012 02/06/2013 08/05/2013 08/05/2013 Barbara Flynn, RN Barbara Flynn, RN Barbara Flynn, RN Barbara Flynn, RN Kaite McGrew Kaite McGrew Herschel Lelaind, Sr. Compliance Specialist Peg Behan, RRT, QI Manager Page 3 of 3 Barbara Flynn, RN Barbara Flynn, RN Barbara Flynn, RN Barbara Flynn, RN Barbara Flynn, RN Barbara Flynn, RN Barbara Flynn, RN CQIW