User Guide — Clinical Provider Selector

 

You can use the options in the clinical provider selector to:

• Add new provider — Click this link to add a new clinical provider.
  New fields appear.
  Fill out each field, and click Add.
  Note: To see the Add new provider link, you must have the Clinicals Admin or Practice Set-Up: Referring Providers/ Numbers permission.
• Use for all orders of this type for this encounter — Select this option to make athenaOne automatically select this clinical provider for all orders of this type.
  The text that appears varies with the order type.
• Set this lab as the patient's preferred lab — Select this option to assign all future lab orders to this clinical provider by default for this patient. If you already selected a lab, it appears on the Patient Labs tab of the selector, on the patient's Quickview, at the Check-in stage, and in the patient chart under Preferred Lab.
• Add to patient's list of pharmacies — Select this option to add the selected pharmacy to the patient's list of pharmacies. The Set as default pharmacy for this patient option appears.
• Set as default pharmacy for this patient — Select this option to assign future prescribed prescription and vaccine orders to this clinical provider by default for this patient.
  • If pharmacies are already selected for this patient, they appear in the Patient Pharmacies tab to the right. The default pharmacy is the first one in the list. The Patient Pharmacies list also appears in the patient chart.
  • The patient's default pharmacy also appears on the patient's Quickview and at the Check-in stage.

• Search — Enter the name of the provider and/or parts of the address or phone number to search for any clinical provider (not necessarily a local partner or athenaCoordinator partner).
• Patient Pharmacies — Select a pharmacy. The list of pharmacies appears only when you order a prescription for a medication or vaccine. It also appears on the Quickview and Check-in pages and in the patient chart.
• Patient Labs — Select a lab. The preferred patient lab appears only when you order a lab test. It also appears on the Quickview and Check-in pages, and in the patient chart.

1. Display the Order Routes page: On the Main Menu, click Settings > Clinicals. In the left menu, under Practice Links — Order Configuration, click Order Routes.
2. To add an order route:
1. Click Add new.
2. Click Search next to the Clinical provider field.
3. To edit an order route:
1. Click edit next to the order route.
2. Click the name of the existing receiver.

 

When you create a referral order for patients who have UnitedHealthcare as their primary or secondary health insurance, you can display a directory of providers that accept UnitedHealthcare insurance when you select the receiving provider for the referral. This feature applies to referral orders for providers, radiology or lab facilities, and ambulatory surgical centers.

Note for practices that use the local networks feature: The UnitedHealthcare payer network application does not interact with your local networks.

 

If your practice limits traffic to specific IP addresses only, you must add the following local traffic manager IP addresses to your list of accepted IP addresses:

• 149.111.164.67
• 168.183.37.254

The UnitedHealthcare website displays:

• Providers in your patient's network
• Patient's out-of-pocket costs for the visit or procedure

athenahealth shares only the minimum necessary information with UnitedHealthcare to ensure proper authentication with their application:

• Username
• Practice/Context ID
• Department ID
• NPI of the ordering provider

Important: To refer your patient to a provider in the UnitedHealthCare directory, your patient must pass an eligibility check. If the patient is eligible, the UnitedHealthcare link is displayed in the clinical provider selector.

 

To consult the Display the UnitedHealthcare Payer Network Directory, follow these instructions.

1. Create and open the referral order.
   • In the Exam stage of an encounter, create a referral order in the Assessment & Plan section, then click the order to display the details.
   • Display the Order Group page: In the patient chart, click the Menu icon and select Create order group. Select the ordering provider and create the referral order. Click the order to display the details.
   • In the Outstanding Orders section of the patient chart briefing, select an outstanding order.
2. Send to — Click the plus icon next to receiver to open the clinical provider selector.
   The Select a clinical provider window opens.
3. Click UnitedHealthcare Provider Search at the top of the clinical provider selector.
   
   The UnitedHealthcare website opens in a new browser tab with the Care Estimator Search page displayed.
4. To search for a provider in the UnitedHealthcare network for this patient, specify the provider specialty, ZIP code, and the search radius.
   Note: For lab referrals, the Care Estimator detects that the order type is a lab and automatically enters relevant data into some sections of the page for you.
5. Select the provider from the list, and then copy and paste the provider name into athenaOne.
6. Complete the order and sign it.

 

Clinical partners are receiving providers that participate in the athenaClinicals service.

 

The following icons appear next to the names of clinical partners.

• (olive branch) — This icon indicates a clinical provider that pays for order transmission services. For referrals, the taxonomy (specialty) of this provider matches the order you are creating.
• (olive branch and plus sign) — This icon indicates a clinical provider that pays for order transmission services and provides additional services, such as insurance verification, preregistration, or precertification upon receiving an order. For referrals, the taxonomy of this provider matches the order you are creating.

For clinical partners, the following information appears:

• Clinical partner's name.
• Taxonomy, for referral orders.
• Distance from the patient's ZIP code to the clinical provider's ZIP code.
• Provider's full address, phone, and fax numbers.
• Direct Messaging address, if available.
• Services included, such as precertification.
• Website for athenaCoordinator Core receivers, if available.

Par indicates that this clinical provider is enrolled (participates) with the patient's insurance at a high level, but does not indicate that the provider will accept the patient's specific insurance package.

Note: This information is available only for providers using athenaCollector. If "Par" is not present, that provider may or may not accept the patient's insurance.

 

 

In a lab, medication, or imaging order, when the default provider is displayed in the Send to field, other preferred providers are displayed at the top of the list in the clinical provider selector, marked by the blue and white star icon.

 

When a non-default preferred provider is displayed in the Send to field for a lab, medication, or imaging order, the default preferred provider is displayed at the top of the selector list, marked by the blue and white star icon.

 

 

You must be logged in to a department that uses athenaClinicals, and you must have permission to access and update the patient chart to access this functionality.

 

To access Local Networks, your practice must have the local networks service turned on, and you must have the Coordinator Admin: Local Networks role to manage local network configurations.

For more information on Local Networks, see the following O-help topics:

• Local Networks
• User Guide — Local Networks

 

You must have the one of the following roles to add new receivers in the Improved CPSW:

• Clinicals Admin

• Practice Set-Up: Referring Providers/ Numbers

 

 

The enhanced clinical provider selector offers robust receiver results to help you select the right receiver for your consult order.

 

When selecting a receiver for your consult order:

• Browse providers near the patient's zip code that accept the selected order type
• Easily view providers in your practice’s local network(s)
• Find providers with a Direct address to help satisfy MIPS requirements
• View all locations for a person provider at a glance
• View frequently used providers by order type and ordering provider

 

For consult orders — you can display the improved clinical provider selector from several areas of athenaOne:

 

 

 

 

 

 

The Add a receiver page of the improved clinical provider selector appears after you go through one of the previously described entry points:

• You first see a list of receivers within 30 miles of the patient’s zip code that accept the selected order type sorted by relevance.
• A receiver accepts the selected order type if it matches the primary specialty listed for them in athenaOne’s global clinical provider database.
  
  For example, a cardiology referral consult order shows nearby receivers with a primary specialty of "Cardiovascular Disease", "Internal Medicine", or "Pediatric Cardiology".
• If your practice has local networks enabled, sorting by relevance lists receivers by network tier and then distance. If you do not have local networks enabled, sorting by relevance is the same as sorting by distance to zip code.
• You can change the default distance radius based on your needs. Rural practices tend to expand the distance filter and urban practices tend to reduce the distance filter. Any changes to the distance filter persist. If you use a different computer, you need to reset your distance filter preference.

 

 

 

 

If you could not find the receiver you are looking for, you can create a new clinical provider and add it to your order.

 

Note: If you add a new clinical provider via the improved clinical provider selector, the provider you added only accepts consult orders. See Suggest a Clinical Provider in O-help for more information on setting up a provider that accepts additional order types.

To add a new receiver

1. When you’re displaying the Add a receiver page, click Add New Receiver to add a new receiving provider.
   
   The Add New Receiver page appears
2. From the two tabs on the page, you can either:
   1. Add New Provider — Enter information in the required fields:
      • First Name — This field is required.
      • Last Name — This field is required.
      • Display Name — This field is required. The display name appears on the providers record and be searchable.
      • NPI — This field is optional.
      • Specialty — This field is optional. The list of options displays the specialty that accepts the selected order type. Not all specialty options are available for selection.
        Note: Order Type – This field is not displayed. The clinical provider created from this workflow will accept consult order types only.
        
   2. Add New Group — Enter information in the required fields:
      • Display Name — This field is required.
      • NPI — This field is optional.
      • Specialty — This field is optional. The list of options displays the specialty that accepts the selected order type. Not all specialty options are available for selection.
        Note: Order Type – This field is not displayed. The clinical provider created from this workflow will accept consult order types only.
3. Location — Enter the required location information:
   • Address — This field is required.
   • City — This field is required.
   • State — This field is required.
   • Zip — This field is required.
   • Primary Phone — This field is required.
   • Fax — This field is required.
   • Direct Address — This field is optional.
     
4. Click Add.
   Note: The Add button is inaccessible until you fill all required fields. After you click Add, the group is added to our clinical provider records.

 

 

 

 

When you create a referral order for patients who have UnitedHealthcare as their primary or secondary health insurance, you can view a carousel at the top of the Add a Receiver page. When you select the receiving provider for the referral, preferred providers that accept UnitedHealthcare insurance display in the carousel. This feature applies to consult orders for providers.

 

If the patient has UnitedHealthcare insurance, you’ll notice an improved experience:

 

When you hover over the provider in the carousel, the box highlights blue. Click the box to automatically select the provider.

• A message appears when you hover over the UnitedHealthcare Suggestions heading that says, "UnitedHealthCare suggests these providers based on their cost and quality analysis".
  
• Click the arrow icon next to UnitedHealthcare Suggestions to reveal the carousel of suggestions.
  
• There is no Provider Details page for providers when they appear in the UnitedHealthcare Suggestions carousel.

The heart icons that appear in the carousel are specific to the provider and how UnitedHealthcare categorizes them:

• 2 Hearts indicates a “Premium Care Physician.”
  
• One Heart indicates a “Quality Care Physician.”
  
• No hearts indicates "Not Evaluated For Premium Care”
  
  
  
  You may also notice:
  • Icons appear that say Tier 1 or Tier 2. For more information on tiers, see UnitedHealthcare® Tiered Benefit Plans on the UnitedHealthcare website.
    
  • An estimated out of pocket cost for the patient. However this field may not appear often as it only displays if UnitedHealthcare receives a CPT procedure code with the eligibility check.
    

Information for practices that use the local networks feature: The UnitedHealthcare payer network application does not interact with your local networks.

 

The UnitedHealthcare suggestions displays:

• Providers in your patient's network
• Preferred provider designations
• Patient's estimated out-of-pocket costs for the visit

athenahealth shares only the minimum necessary information with UnitedHealthcare to ensure proper authentication with their application:

• Username
• Practice/Context ID
• Department ID
• NPI of the ordering provider

Important: To refer your patient to a provider in the UnitedHealthCare directory, your patient must pass an eligibility check. If the patient is eligible, the UnitedHealthcare provider suggestions are displayed in the clinical provider selector.

 

The enhanced clinical provider selector offers robust receiver results to help you select the right receiver for your imaging or lab order.

 

 

You must be logged in to a department that uses athenaClinicals, and you must have permission to access and update the patient chart to access this functionality.

 

To access Local Networks, your practice must have the local networks service turned on, and you must have the Coordinator Admin: Local Networks role to manage local network configurations.

For more information on Local Networks, see the following O-help topics:

• Local Networks
• User Guide — Local Networks

 

You must have the one of the following roles to add new receivers in the Improved CPSW:

• Clinicals Admin

• Practice Set-Up: Referring Providers/ Numbers

 

 

Note: The improved clinical provider selector is not available from the Quickview or Check-in pages.

 

You can quickly enter the clinical provider selector from various locations.

 

 

 

 

The "Add a receiver" page of the clinical provider selector appears after you go through one of the previously described entry points:

• You first see a list of receivers within 30 miles of the patient’s zip code that accept the selected order type sorted by relevance.

• A receiver accepts the selected order type if it matches the primary specialty listed for them in the athenaOne System’s global clinical provider database.
  

• If your practice has local networks enabled, sorting by relevance lists receivers by network tier and then distance. If you do not have local networks enabled, sorting by relevance is the same as sorting by distance to zip code.
• You can change the default distance radius based on your needs. Rural practices tend to expand the distance filter and urban practices tend to reduce the distance filter. Any changes to the distance filter persist. If you use a different computer, you need to reset your distance filter preference.
  

When you display the Add a receiver page, there are default filters and a default sort order:

• Filters allow you to refine the shown results. Default filters include:
  • Local networks — This filter only appears if your practice has the Local Networks service turned on.
    
  • The sorting order determines order of shown results. The default sorting order is by relevance.
    
  • Within 30 miles from zip code — You can set a more applicable distance within the patient's or practice's zip code, or manually enter a valid US ZIP code. Available options include: 10 miles, 30 miles, 50 miles, 100 miles, or any distance. Any changes to the distance filter persist. If you use a different computer, you need to reset your distance filter preference.
    

 

You can now:

• See a message when the practice and patient ZIP codes are invalid or when a manually entered ZIP code is invalid.
  

• Select a preference for the type of ZIP code. You can select Patient ZIP code or Practice ZIP code. The athenaOne System remembers your preferred ZIP code type. Hover over the info icon to reveal a message about the Default preference field.
  

• Switch between patient and practice ZIP code by clicking Switch to [Type of] ZIP code. Switching between ZIP code types via this link does not affect your preferred ZIP code type when the Add receiver window opens.

From here you can

1. Browse the pre-filtered results: you can apply your own filters, or search receivers.
   
2. Click anywhere on the row to select a receiver and add them to the consult order.
   The row turns blue when you hover your cursor over it.
   

3. Click the more options icon or the [Number] more locations link in the Location column (if it appears) to display the Receiver Details page.
   

   Tip: In the receiver row:

   • A green outline indicates that this receiver is in the ordering providers local network. The name of the local network appears below the receivers specialty.

   • The initials in the icon indicate the receiver is a person.

   • An image of multiple people (avatars) in the icon indicates the receiver is a non-person, group, or practice.

   • A leaf icon next to the provider's circle icon indicates a coordinator core partner.

   • An image of a stethoscope (avatar) in the icon indicates the receiver does not have a display name

Note: The Receiver Details page provides a consolidated view for all clinical provider records related to a specific receiver’s NPI number.

 

 

 

 

If you could not find the receiver you are looking for, you can create a new receiver and add it to your order.

1. When you’re displaying the Add a receiver page, click Add New Receiver to add a new receiver.
   
   The Add New Receiver page appears.
2. Add New Group — Enter information in the required fields:
   • Display Name — This field is required.
   • NPI — This field is optional.
   • Specialty — This field is optional. The list of options displays the specialty that accepts the selected order type. Not all specialty options are available for selection.
     
     
3. Location — Enter the required location information:
   • Address — This field is required.
   • City — This field is required.
   • State — This field is required.
   • Zip — This field is required.
   • Primary Phone — This field is required.
   • Fax — This field is required.
   • Direct Address — This field is optional.
     
4. Click Add. The Add button is inaccessible until you fill all required fields. After you click Add, the group is added to our clinical provider records.

 

 

 

 

 

The enhanced clinical provider selector offers robust receiver results to help you select the right receiver for your procedure and surgery order.

 

 

You must be logged in to a department that uses athenaClinicals, and you must have permission to access and update the patient chart to access this functionality.

 

To access Local Networks, your practice must have the local networks service turned on, and you must have the Coordinator Admin: Local Networks role to manage local network configurations.

For more information on Local Networks, see the following O-help topics:

• Local Networks
• User Guide — Local Networks

 

You must have the one of the following roles to add new receivers in the Improved CPSW:

• Clinicals Admin

• Practice Set-Up: Referring Providers/ Numbers

 

 

Note: The improved clinical provider selector is not available from the Quickview or Check-in pages.

 

You can quickly enter the clinical provider selector from various locations.

 

 

 

The "Add a receiver" page of the clinical provider selector appears after you go through one of the previously described entry points:

• You first see a list of receivers within 30 miles of the patient’s zip code that accept the selected order type sorted by relevance.

• A receiver accepts the selected order type if it matches the primary specialty listed for them in the athenaOne System’s global clinical provider database.
  
  

• If your practice has local networks enabled, sorting by relevance lists receivers by network tier and then distance. If you do not have local networks enabled, sorting by relevance is the same as sorting by distance to zip code.
• You can change the default distance radius based on your needs. Rural practices tend to expand the distance filter and urban practices tend to reduce the distance filter. Any changes to the distance filter persist. If you use a different computer, you need to reset your distance filter preference.

When you display the Add a receiver page, there are default filters and a default sort order:

• Filters allow you to refine the shown results. Default filters include:
  • Local networks — This filter only appears if your practice has the Local Networks service turned on.
    
  • Sort by — The sorting order determines order of shown results. The default sorting order is by relevance.
    
  • Within 30 miles from zip code — You can set a more applicable distance within the patient's or practice's zip code, or manually enter a valid US ZIP code. Available options include: 10 miles, 30 miles, 50 miles, 100 miles, or any distance. Any changes to the distance filter persist. If you use a different computer, you need to reset your distance filter preference.
    

You can now:

• See a message when the practice and patient ZIP codes are invalid or when a manually entered ZIP code is invalid.
  

• Select a preference for the type of ZIP code. You can select Patient ZIP code or Practice ZIP code. The athenaOne System remembers your preferred ZIP code type.
  
  Hover over the info icon to reveal a message about the Default preference field.
  

• Switch between patient and practice ZIP code by clicking Switch to [Type of] ZIP code. Switching between ZIP code types via this link does not affect your preferred ZIP code type when the Add receiver window opens.
  

 

From here you can

1. Browse the pre-filtered results: you can apply your own filters, or search receivers.
   
   
2. Click anywhere on the row to select a receiver and add them to the consult order.
   The row turns blue when you hover your cursor over it.
   

   Click the more options icon or the [Number] more locations link in the Location column (if it appears) to display the Receiver Details page.

Tip: In the receiver row:

• A green outline indicates that this receiver is in the ordering providers' local network. The name of the local network appears below the receiver's specialty.

• The initials in the icon indicate the receiver is a person.

• An image of multiple people (avatars) in the icon indicates the receiver is a non-person, group, or practice.

• A leaf icon next to the provider's circle icon indicates a coordinator core partner.

• An image of a stethoscope (avatar) in the icon indicates the receiver does not have a display name

 

Note: The Receiver Details page provides a consolidated view for all clinical provider records related to a specific receiver’s NPI number.

 

 

 

 

If you could not find the receiver you are looking for, you can create a new receiver and add it to your order.

1. When you’re displaying the Add a receiver page, click Add New Receiver to add a new receiver.
   
   The Add New Receiver page appears.
2. Add New Group — Enter information in the required fields:
   • Display Name — Required.
   • NPI — Optional.
   • Specialty — Optional. The list of options displays the specialty that accepts the selected order type. Not all specialty options are available for selection.
     
     
3. Location — Enter the required location information.
   
4. Click Add.
   
   The Add button is inaccessible until you fill all required fields. After you click Add, the group is added to our clinical provider records.

 

 

 

Before you can use this feature, you must set clinical provider selector to have the Local Networks filter on by default on the Local Networks page.

 

To access Local Networks, your practice must have the local networks service turned on. To enable it for your organization, contact your CSM or your onboarding project team. On the Main Menu, click Support then Create Case or Call.

 

You must be logged in to a department that uses athenaClinicals, and you must have permission to access and update the patient chart to access this functionality.

 

To access Local Networks, your practice must have the local networks service turned on, and you must have the Coordinator Admin: Local Networks role to manage local network configurations.

For more information on Local Networks, see the following O-help topics:

• Local Networks
• User Guide — Local Networks

 

You must have the one of the following roles to add new receivers in the Improved CPSW:

• Clinicals Admin

• Practice Set-Up: Referring Providers/ Numbers

 

 

Your practice can manage this setting on the Local Networks page:

1. On the Main Menu, click the Settings icon .

2. Under ADMIN, click Coordinator.

3. In the Task Bar, under PRACTICE LINKS — Relationships, click Local Networks.

 

To set the new default experience, in the Manage CPSW Settings section, set the Filter by Local Network option to On and click Save.

 

With the setting on, when you open the improved clinical provider selector, all the Local Networks under the Local Networks filter will be checked by default. You’ll only see providers that are part of a local network and accept the order type. Filters can be adjusted to expand or reduce the results.

 

There are two ways that you can find providers outside of a local network even if your default experience shows local networks upon opening the clinical provider selector:

• Uncheck the local networks under the Local Networks filter.

• Type in the search bar ( the Search receivers field). Regardless of whether Local Networks are selected as a filter, this searches outside the local networks and returns all results. Local network receivers are toward the top of the list with your frequently used refer-to providers.

Regardless of the filters you selected the last time you used the improved clinical provider selector, the default to limit results to your Local Networks will be reapplied every time you open the selection widget.

If no providers are available in your local network for the selected order, your user must clear the local network filter to view non-local network providers.