Explore the Provider Service Delivery Workflow
Learning Objectives
After completing this unit, you’ll be able to:
- Describe Provider Management components and capabilities.
- Explain the end-to-end workflow for caseworkers and providers to complete referrals.
Before You Start
Before you start this module, make sure you complete the following content. The work you do here builds on the concepts and work you do in that content.
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Provider Management Data Model in Public Sector Solutions
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Benefit Management Data Model in Public Sector Solutions
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Social Program Data Model in Public Sector Solutions
Manage Your Provider Network and Referrals
Caseworkers are no strangers to challenges. Every day, these unsung heroes respond to complaints, meet with constituents, review benefit applications, and craft care plans to resolve issues that their clients face. If these tasks weren’t challenging enough, caseworkers also coordinate with providers outside the agency to set up the delivery of specialized services for constituents. Services are things like job counseling, healthcare, child and senior welfare, and housing assistance.
The provider networks that agencies manage are often large and complex. Caseworkers must sift through mountains of information to pinpoint qualified professionals who offer the exact service to remedy a constituent’s problem. Even after they find the right provider, caseworkers spend hours talking on the phone or sifting through emails to complete referrals.
Inefficient communication adds to the complexity, as agencies are hard-pressed to track whether constituents use their assigned benefits. Plus, agencies must arrange for timely payments to service providers. Surely, there must be a way to bridge this communication divide.
In the Provider Management Data Model in Public Sector Solutions module, you learned how Provider Management strengthens this collaboration and streamlines the sharing of critical information between agencies and providers.
To recap, Provider Management includes these powerful features:
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Data model: It stores and organizes the details of each provider, including specialties and facilities, during provider registration and certification. The data model also stores constituent data, available benefits, and care plans.
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Provider Search: Caseworkers use it to quickly identify providers based on specific criteria and then launch a referral directly from the search results.
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Provider Referral guided flow: The flow simplifies the collection and communication of important information that providers require to process referrals.
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Provider Portal Experience Cloud: The site gives providers and caseworkers a common platform to share information, manage referrals, and capture constituent progress.
In this module, you learn how to configure and use these features to strengthen the collaboration between your agency and your provider network.
Discover the Provider Service Delivery Workflow
As you learned in the Social Program Management Data Model in Public Sector Solutions and Benefit Management Data Model in Public Sector Solutions modules, the government agency admin sets up the Public Sector Solutions org by configuring programs, benefits, goals, and other records that caseworkers can assign to constituents. The agency caseworker manages applications, complaints, and cases to identify the issues that constituents face. To solve problems and bring about positive outcomes for constituents, they set up a care plan with assigned goals and benefits.
However, what if the agency can’t deliver a particular benefit to a constituent? Or, what if the agency relies on a partnership with another organization? In these situations, the caseworker must quickly pinpoint and request help from a provider or individual specialist who can fill the gap. This is where the Provider Service Delivery Workflow helps deliver the right support. By using Provider Management objects and tools, the workflow speeds provider identification, information sharing, and service-delivery tracking.
This diagram illustrates the steps in the Provider Service Delivery Workflow.
This table shows each step of the workflow, the person responsible for the task, and additional details about the process step.
Workflow Step |
Person Responsible |
Description |
|---|---|---|
Search for providers and refer constituents (1) |
Caseworker |
After assigning a benefit, the caseworker searches the network of providers and narrows down the list to a set of specialized organizations or individual practitioners that can deliver the intended benefit. The caseworker creates and submits a referral to request service from one or more providers. |
Accept referrals and request authorization (2) |
Provider Employee |
In the provider portal, a provider employee reviews the referral request. If the service provider determines that they have the resources available to assist the constituent, they request authorization from the agency to begin the service. |
Authorize service delivery referrals (3) |
Caseworker |
The caseworker reviews all authorization requests from service providers, and approves requests from preferred providers. |
Schedule and sessions exist? (4) |
Provider, Caseworker |
Back in the provider portal, the provider receives notification of the approved referral. They check if a session schedule already exists for the constituent. If a schedule exists: The provider enrolls the constituent in one or more available sessions. If no schedule exists:
|
Enroll constituents in sessions (5) |
Provider |
In the provider portal, the provider enrolls the constituent into one or more of the approved benefit sessions. Then a flow creates a benefit disbursement record for each session enrollment. |
Track constituent attendance (6) |
Provider |
The provider updates the Attendance page of the provider portal to record the constituent’s progress toward receiving the benefit. The disbursement records are automatically updated with the disbursed quantity of benefits. Caseworkers can periodically review this information to track the constituent’s progress toward improved outcomes. |
Now that you have a feel for the Provider Service Delivery Workflow, consider a scenario. Tishon, the Salesforce admin for the City of Cosville, is working to configure the agency org to use Provider Management.
Her goal is to help Connor, the agency caseworker, ‌deliver constituent benefits faster and more efficiently. Connor is currently focused on a case that involves Steve Marshall, who is facing a number of challenges. So far, Connor has developed a care plan with targeted benefits to help Steve. He’s received most of the assigned benefits and is progressing well through his care plan.
However, Steve’s wife recently passed away, so Connor also wants to connect Steve with mental health professionals so that he can receive counseling. Since the City of Cosville doesn’t have dedicated grief counselors, Connor needs to refer Steve to a provider who specializes in delivering that particular benefit. Sounds like Connor is ready to begin the Provider Service Delivery Workflow.
In the following units, you follow Connor as he uses Provider Management features to collaborate with an external provider to get Steve the help he needs. You also learn the steps that Tishon takes to set up the org with these features.
It’s time to see firsthand how Provider Management enhances and speeds up the referral process so that your constituents can receive timely assistance. In the next unit, you learn about how to set up and use Provider Search.