Healthcare Coordination FAQ

What is Healthcare Coordination (HCC)?

Healthcare Coordination (HCC) involves working closely with patients to ensure they receive timely and appropriate care when they need treatment from specialty providers or providers outside of our organization. HCCs connect patients to a wide range of specialty care, such as cardiology, neurology or behavioral health care, as well as to advanced diagnostic imaging and testing. HCCs act as liaisons among patients, healthcare providers, and insurance companies to facilitate referrals, schedule appointments, and address any barriers to care. This role is essential in helping our patients navigate the complex healthcare system.

Team Roles and Responsibilities:

HEALTHCARE COORDINATOR (HCC)

The HCC assists patients with coordinating their referrals and breaks down barriers to care, such as language, transportation, and cost. They schedule specialty and imaging appointments, follow up on consultations and test results, and document the process in the EMR to facilitate communication among the care team members.  Additionally, they track referrals to confirm that they were completed and that all necessary paperwork is in place.  If needed, they ensure that insurance referrals and prior authorizations are processed before the patient’s appointments.

Prior authorization coordinator (pac) for advanced imaging/procedures

The PAC manages prior authorization requests for advanced imaging or procedures such as MRIs, CT scans, PET Scans, Nuclear Medicine studies, Sleep studies, and Cardiology testing. They work with insurance providers and specialty facilities to obtain approval before these procedures are scheduled, ensuring that the necessary documentation is submitted promptly.  

Prior authorization coordinator (pac) for medication

The PAC, like the PAC for imaging and procedures, obtains prior authorizations for medications. They work with insurance companies to ensure coverage for prescriptions, including high-cost or specialty medications.  By addressing prior authorization requests quickly, PACs help prevent delays in care.

Gynecological surgery scheduler (GYN ss)

The GYN SS coordinates all aspects of scheduling gynecological surgeries, ensuring that patients have the necessary prior authorizations, paperwork, and follow-up appointments. They work closely with the surgical team and patients to make sure that surgeries are scheduled promptly and that the process is smooth for all involved.

By working collaboratively, HCCs, PACs, and the GYN SS provide essential services that help streamline the care process, improve patient outcomes, and reduce the administrative burden on healthcare providers.

How can I help a patient access healthcare coordination services?

HCC services are available to all Westside patients at no additional cost. To connect a patient to a healthcare coordinator, you can place an HCC referral order, send a message to the “Referrals” pool for your site team, or send a Teams chat message to the HCC group on Teams.  

What kind of referral orders are available in our EHR?

Urgent referral order

These are time-sensitive referrals for care that the patient needs immediately to avoid a possible negative outcome. These referrals are treated with priority to ensure patients receive care as quickly as possible.

Healthcare Coordinated Referral Oorder (HCC)

HCC referrals are used when a patient or the provider has identified a barrier (e.g., language, transportation, uninsured, underinsured, etc.) that prevents the patient from scheduling the appointment on their own.

Patient Coordinated Referral Order (PCR)

Providers place a PCR order in cases where the patient can arrange an appointment. The HCC provides the necessary resources and support, following up to confirm that the patient attended their appointment and that the appropriate consultation notes or results were received.