CommuniCare Referral Monitoring Process

CommuniCare implements a comprehensive referral monitoring policy to ensure exceptional service delivery through consistent, timely client communication. Our established framework outlines specific protocols for monitoring, with heightened attention to at-risk or vulnerable clients, as well as those who may require additional support in navigating their service journey.

This structured approach ensures comprehensive client support, with a focus on:

• Reviewing outstanding referrals during consultations to maintain service delivery.
• Taking proactive steps to resolve pending matters to ensure delivery of services.
• Ensuring seamless service coordination across all touchpoints while remaining transparent.

No matter where the client’s journey leads them, this framework adaptively maintains continuity of care, weaving a safety net of accountability that empowers our clients to navigate their complexities with confidence.

Partner Referral Response Standards

The following will cover: referral response time monitoring, follow-up quality assurance with clients for services, and closing the loop on referrals.

• Initial Response Time: 2 business days from referral receipt
  • This is the time frame for users to respond to referrals they have received for their services and to help identify if the referral has been accepted or declined by the user to provide services to the client.
• Grace Period: Additional 2 business days
  • This grace period is in place to allow room for users and clients to respond and communicate in a timely manner.
• Custom Arrangements: Referral responses may be adjusted beyond the 2 business day standard based on established agreements between partner organizations and CommuniCare.
  • For organizations that are seasonal or have unique open hours and have limited time to respond to referrals.
  • Those experiencing staffing shortages and capacity issues inhibiting their ability to respond to referrals within 2 business days.

CommuniCare Referral Auditing Process

• Audit of referral statuses by CommuniCare staff to occur bi-weekly, every 10 business days (with exclusion of holidays and closures).
  • This audit will be to monitor the flow of referrals coming and going through the CommuniCare platform.
  • A data report will be conducted to get a closer look at the timeframe in which referrals are being made and if the users are engaging in client interactions.
  • This audit is also to ensure that appropriate referrals are being made in the system and are being accepted/declined and marked as services provided in a timely manner.

Providing Services Response Standards

• Expected duration to close the loop on a referral: Best practices suggest two-weeks to no longer than two-months for users that have been providing services to mark that services have been provided or were unable to deliver services, tailored to individual client needs and desired outcomes.
  • If services cannot be provided, provide a brief description as to why so it can be recorded on the client file and the loop can be closed.

CommuniCare Closed Loop Audit Process

• Progress Review: Systematic evaluation will be consistently conducted by CommuniCare staff to assess referral and service status and optimize service delivery
  • Every eight weeks, CommuniCare staff will run a report to verify that processes are being followed appropriately and to evaluate that the referral loop is being closed.

Accountability Framework

The accountability framework that underpins our client-centric approach is built upon a foundation of shared responsibility:

• Initial Case Manager: Initial Case Manager maintains primary oversight of client’s case management, guiding the process and intervening as needed to resolve open referrals.
  • Initial Case Manager will be the primary case manager used in the referral process.
  • In the case that a client is referred to a service with more advanced case management services, the client may choose to work with the case manager at the location where services are being provided.
• External Referrals: In the event a client does not have a case manager, users who initiate out-of-network referrals remain responsible for follow-up and closure of services provided, otherwise that responsibility falls on the client’s primary case manager.
  • The client’s primary case manager (if the client has one) will be responsible for communicating with the client and closing out the referral process by marking in the client record that services were or were not provided.
• User Account Expectations: As part of being a user within CommuniCare, we do ask that you are mindful of the following to ensure best practice and overall utilization:
  • Users will log into the platform weekly to verify no unread notifications or referrals are left unanswered and to ensure that their account will not be deactivated due to inactivity.
  • If the user has the role of a navigator or operator in the platform and does not log into the system for 120 days, the account will be deactivated.
  • If the user is an entity admin in the platform and does not log in for 180 days, the account will be deactivated.
• Consent Expectations: In the event users need to deauthorize or revoke consent for a client, the following steps should be followed:
  • Deauthorizing consent for an entity – When a client wishes to deauthorize consent for a specific entity, the request must be initiated by the client. Once this request has been verified, an entity admin user who is part of the care team may proceed with removing the entity the client no longer wishes to work with. As part of this process, the user performing the removal must document the action in a case note to inform the rest of the care team.
  • Revoking Consent – When a client wishes to revoke consent from their profile, the request must be initiated by the client. Once the request has been verified, an entity admin user who is part of the care team may proceed with revoking the client’s consent. Before doing so, the verifying entity admin must notify the client’s current care team of the revocation request. After the care team has been informed, the entity admin must document the action in a case note. Once these steps are completed, the entity admin may proceed with revoking the client’s consent.

Failure to Abide by CommuniCare Referral Response Standards

If users are not consistently responding to referrals or closing the loop on referrals they’ve received, follow-up by CommuniCare staff may be conducted to offer assistance, additional training, and if necessary, to terminate the user from the system.

Notice to CommuniCare Staff of New Users

Under no circumstances can an individual use the system on another user’s account. If it is discovered that a user’s account has been accessed by someone without the proper authority, the account will be terminated and the event will be treated as a data breach

• If new users are brought onto the platform, even to replace a prior user, the CommuniCare Specialist or Program Manager must be notified, as creation of an account, placing roles, and trainings are required before a user can utilize the system.
• If a user is leaving the system and the position is not expected to be replaced, the CommuniCare Specialist or Program Manager must be notified within 48 hours (2 days) after employee terminations so the user’s account can be locked or canceled, as costs associated to user fees are incurred by Wyoming 211.