VA Form 10-10143 Screenshot

Appointing Process Steps & Scripts (CSR I)

Purpose
Script
CSR receives assigned tasks list from
Supervisor (Assignment process may N/A
vary)
CSR uses Authorization number to find
N/A
Vet info in CareRadius
CSR reviews 'Documentation' tab in
CareRadius to determine appointing
information. Review to understand
appointing requirements.
CSR searches the list of potential
network providers suggested to the
Vet in CareRadius.
CSR calls provider to schedule an
appointment
Decision Point: Determine if the
provider is able to schedule an
appointment within 30 days. [Attempt
to schedule an appointment with the
provider based on the Veteran's
preferred date and time saved in VPA]

N/A

N/A
"Hi, this is [name] from TriWest and we have a Veteran who would like to make an
appointment with Dr. [name]."
"When is the earliest time and date you are able to schedule the appointment?"
[Ensure that the appointing is within 30 days]
[If it's non-service connected, advise the provider of this determination and the
requirement to bill the Veterans OHI before billing VA]

Decision Point: [Provider is unavailable
to schedule within 30 days] CSR
N/A
identifies the next network provider
within the searched list.
If CSR cannot find any available
network providers, task it to CSR II
'Searchers' team in CareRadius.
Decision Point: [Provider is available to
schedule within 30 days] Does the
N/A
provider require additional
information prior to the appointing?
If provider doesn't require additional
information, CSR updates
authorization and completes the
appointment assessment.

N/A

CSR notifies the Vet of the
appointment information via the Vet's N/A
communication preference.
CONFIDENTIAL

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CareRadius sends out an automated
appointing reminder to the Vet via 72 N/A
and 24 hours prior to the appointing.
Updated authorization is automatically
N/A
notified to VA via portal.
CSR notifies the updated authorization
N/A
to the provider via Fax Browser.
If the provider requires additional
information, determine if the provider
N/A
wishes to speak with the Vet prior to
the appointing.
CSR reaches out to the Vet to inform
"I have talked with Dr.[name] to schedule your appointment. You can expect a phone
that the provider will be contacting the
call from the provider to ask you for additional information."
Vet for additional information.
CSR waits for the provider to call back
within 5 business days. If provider
"I am calling to follow-up on the appointing schedule confirmation for [Vet's name]
doesn't follow-up, CSR actively reaches requested on [date]?"
out to the provider after five days.
Decision Point: Is the provider willing
to accept and appoint the Vet for a
visit? If yes, then update the
N/A
authorization in CareRadius. If no, start
with the next network provider search
[APPT-007].
If the provider requests to review the
Vet's medical documentation,
determine if pertinent information can N/A
be pulled in CareRadius and/or Fax
Browser.
Decision Point: Determine if the
N/A
requested documentation is available.
If CSR can track requested
documentation, task it to the Med Doc
N/A
team in CareRadius to fax the relevant
documents to the provider's office.
Determine if the provider requests for
N/A
additional medical documentation.
If additional medical documentation is
not available, CSR requests them to VA
through portal. Upon receipt, VA will N/A
directly send the documentations to
the provider's office.

CONFIDENTIAL

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