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Letters Out

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Providers may often want to send letters containing patient Assessment and Plan information to Referring Providers. Similarly, they may engage in various communication tasks with patients, Insurance Companies, and specialists, among others. The Letters Out feature streamlines the process of generating letters efficiently by utilizing predefined templates. These templates are tailored to the current encounter, ensuring that all relevant details are readily available. Field Descriptions: Add: Click this button to open a blank Letters Out screen and create a new letter. Search: Click this button to view all existing letters for the selected patient. The search popup displays the details of the letter, such as the date, subject, status, and the recipient(s). To: The dropdown list displays a selection of recipients to whom the letter can be sent. The recipients are determined based on specified conditions, which include: Referring Provider: If the Billing module is available for the clinic, then the name of the Referring Provider on the Billing side is displayed. If the Billing module is available for the clinic, then the name of the Referring Provider of the current encounter on the EMR side is displayed. If the Referring Provider is not present in the encounter, then the one associated with the patient on the Patient Registration screen is displayed. Referred to Provider: Visible if there is a Referred to Provider set from the Edit Existing Encounter screen. Patient: The default value displayed in the dropdown list is the name of the currently selected patient. Others Employer: Visible if the Employer details have been entered for the patient on the Patient Registration screen. The Employer name can either be selected from the search or added manually. Patient's Primary Insurance: Visible if the Patient's Primary Insurance details are available on the Patient Insurance popup. Patient's Secondary Insurance: Visible if the Patient's Secondary Insurance details are available on the Insurance popup. Patient's Tertiary Insurance: Visible if the Patient's Tertiary Insurance details are available on the Insurance popup. Emergency Contact: Visible if the patient's Emergency contact details have been entered in the system (i.e., on the Patient Registration screen → section: Emergency Contact Details). Spouse/ Parent/ Legal Guardian (SPL): Visible if any of the patient's relationship details have been entered in the system (from the Patient Registration screen → section: Spouse/Parent/Legal Guardian details). Subscriber Primary Insurance: Visible if the name of the policy holder or Subscriber of the Patient's Primary Insurance is other than self, as entered in the system via the Insurance popup. Subscriber Secondary Insurance: Visible if the name of the policy holder or Subscriber of the Patient's Secondary Insurance is other than self, as entered in the system via the Insurance popup. Subscriber Tertiary Insurance: Visible if the name of the policy holder or Subscriber of the Patient's Tertiary Insurance is other than self, as entered in the system via the Insurance popup. Primary Care Physician 1: Visible if the name of the first Primary Care Physician has been entered from the Physician tab on the Patient Registration screen. Primary Care Physician 2: Visible if the name of the second Primary Care Physician has been entered from the Physician tab on the Patient Registration screen. Primary Care Physician 3: Visible if the name of the third Primary Care Physician has been entered from the Physician tab on the Patient Registration screen. Primary Care Physician 4: Visible if the name of the fourth Primary Care Physician has been entered from the Physician tab on the Patient Registration screen. Primary Care Physician 5: Visible if the name of the fifth Primary Care Physician has been entered from the Physician tab on the Patient Registration screen. Responsible Person: Visible if the patient's Responsible Person entered is NOT equal to self. Responsible Person is added from the Billing tab on the Patient Registration screen. Primary Insurance Attorney: Visible if the Primary Insurance of the patient has the Attorney details entered from the Insurance popup. Secondary Insurance Attorney: Visible if the Secondary Insurance of the patient has the Attorney details entered from the Insurance popup. Tertiary Insurance Attorney: Visible if the Tertiary Insurance of the patient has the Attorney details entered from the Insurance popup. Primary Insurance Adjustor: Visible if the Primary Insurance of the patient has the Adjustor details entered from the Insurance popup. Secondary Insurance Adjustor: Visible if the Secondary Insurance of the patient has the Adjustor details entered from the Insurance popup. Tertiary Insurance Adjustor: Visible if the Tertiary Insurance of the patient has the Adjustor details entered from the Insurance popup. Patient Attorney: Visible if the patient's attorney's name has been entered on the Billing Info tab on the Patient Registration screen. Patient Adjustor: Visible if the Patient Adjustor's name is entered in any Case associated with the patient from the Case Management popup. Case Manager 1: Visible if the first Case Manager's name has been added from the Case Management popup. Case Manager 2: Visible if the second Case Manager's name has been added from the Case Management popup. Case Manager 3: Visible if the third Case Manager's name has been added from the Case Management popup. Rendering Provider (Billing): Visible if the Billing module is ON and the Rendering Provider's details are available with the Patient's Claim details. Attending Provider (Billing): Visible if the Billing module is ON and the Attending Provider's details are available on the Patient's Registration screen. Operating Provider: Visible if the Billing module is ON and the UB04 form details have the Operating Provider's name or details entered. Operating Assistant Provider 1: Visible if the Billing module is ON and the UB04 form details have the first Operating Assistant Provider's name or details entered. Operating Assistant Provider 2: Visible if the Billing module is ON and the UB04 form details have the second Operating Assistant Provider's name or details entered. Case Insurance Company: Visible if a case is present for the patient and if insurance has been assigned to this case from the 'Insurance/Employer/Patient' section on the Case Management popup. Case Insurance Attorney: Visible if an Attorney has been assigned to the case from the Case Management popup. Case Insurance Adjustor: Visible if an Adjustor's details have been entered for the Insurance in the case from the Case Management popup. Case Patient Attorney: Visible if an Attorney has been assigned to the patient from the Case Management popup. Case Patient Adjustor: Visible if an Adjustor's details have been entered for the patient in the case from the Case Management popup. Collection Agency: Visible if a Claim has been sent to a collection agency. Encounter Case Employer: Visible if a case has been assigned specifically to an Encounter via Edit Encounter. Encounter Case Employer Job: Visible if an Employer Job has been associated with a case from the Insurance popup. Claim Case Employer: Visible if an Employer Job has been associated with a case from the Insurance popup. Claim TPA (Third Party Agency): Visible during the processing of a Claim having Employer details and also the third-party agency details associated (from the Employer's TPA Master screen). Claim Employer TPA Contact: Visible if the associated TPA agency has a contact person's name entered in the records. TOC: Select the checkbox if the user is sending a Transition of Care, and it is counted in the Health Information Exchange (Send Summary of Care Records) measure. SOC Req: Select the checkbox if the user is requesting the Summary of Care and it is counted in the Receive and Incorporate measure of MU3. Sender: Displays the patient's Attending Provider's name by default. Clicking the Providers Search icon invokes the Providers Search popup, which displays all medics with a DR Type. Upon selecting a Provider from the popup, the selected Provider is displayed next to the Sender label. Note: For every new letter on the Letters Out screen, the Attending Provider of the last encounter is displayed as the Sender by default, whereas a manually selected Sender is restricted only to that particular letter. If the Sender has been changed to someone other than the Attending Provider of the last encounter and the letter has been saved and sent, then the Search icon becomes unclickable. Patient: Displays the patient's name. To select another patient, click the Patient Search icon . Clicking the Patient Info icon: displays the selected patient's demographic details. DOS: This field shows the date of the encounter i.e., the date of service of the selected patient. By default, the date of the latest encounter is shown. A Select Encounter Search icon is present next to the DOS field. Clicking the Select Encounter Search icon invokes the Patient Encounter List popup, which shows the list of all the encounters of the patient (including zero-duration encounters), irrespective of their encounter status, i.e., Open or Closed. If the value of the letter.use.associate.options property is set to On, the Associate Letter To icon is displayed on the Letters Out screen instead of the DOS field. The user can click this icon to invoke the Associate Letter To popup. Patient Encounter List Popup: The Patient Encounter List popup displays the following configurable columns: Date: This column shows the date of the encounter in MM DD YYYY format. Type: This column shows the type of encounter, including zero-duration encounter types. Person: This column shows the first and last name of the provider associated with the patient's respective encounter. Reason of Visit: This column shows the patient's reason for the visit, which is auto-populated from the reason added in the Reason field on the Start/Edit Encounter screen. Status: This column shows the encounter status of the patient, such as Open and Closed. Case No.: This column shows the Case No. associated with the patient's encounter. Note: In order to accommodate the DOS field and the Select Encounter Search icon, the Sender and the Patient fields have been truncated, displaying only 15 characters. The tooltip displays the full name of the Sender and the Patient, respectively. In case a letter was created for an incorrect encounter and then the user clicks the Select Encounter Search icon to select the correct encounter, the letter displayed for the previous encounter is cleared. The user must now create a new letter. In case an encounter is deleted, the letter sent with that DOS will still remain available under Letters Out or Letter Search. After creating the letter, if another patient is selected from the Select Patient popup, invoked by clicking the Search icon in the Patient field, then the letter is cleared and a new letter must be created. The Date of Service (DOS) field displays the last encounter date for the selected patient. Recipient dropdown: This dropdown allows users to include the following users as recipients of outgoing letters: Providers Patient Insurance Companies Employers Address Book Attorney Adjuster Employer Depts Employer Users Employer TPAs Ref Org Org Provider Surescripts Directory The Search icon invokes the respective user's popup to select the desired recipient. Date: Is set to the run date. To/Cc: Select the desired option from the list (i.e., either To or Cc). The first row is always saved as To. Name, E-mail, Fax, and Address: Name is a mandatory field. If the checkboxes for Referring Provider, Referred to Provider, or Patient are selected, these text fields are automatically populated. If one or more medics or patients are selected using the Search button, their names along with the fields stored in the database are populated. The user can also enter an ad-hoc name along with the email, fax, and/or address fields. Email Type: This column displays two dropdown values: Secured and Non-Secured and is displayed only if the property prognocis.n2n.enable is turned On from the Properties Master screen. If any email recipient's email address (selected either from the Email Type dropdown list, or by clicking the Email icon, or entered directly in the field) is non-N2N-secured, then a warning message popup is displayed with the message: Sending patient health data over email is not advisable for HIPAA compliance reasons. Do you want to Continue?. A secure email is sent from this screen only when Clinical Messaging (N2N Messaging) is turned On for the clinic and both the sender's and recipient's email addresses are N2N secure. If a user (sender) selects Secure from this dropdown but enters a recipient email address that is not N2N secure in the Email Address field, then an error message popup is displayed when an attempt is made to save the letter. The message popup prompts the user to change the Email Type to Non-Secure or to enter an N2N secure email address for the recipient. The row number for the non-N2N secure email address is mentioned in the message so the user can easily identify and change the email address. The letter cannot be saved and sent until the Email Type or email address is changed. Note:: If the property mail.attachment.password.protect is turned ON, then it allows the user to send a non-secure mail in the following two ways with a password-protected attachment: CCD Attachment: If the email contains a CCD attachment, then the consolidated PDF and CCD files (XML and HTML files) are zipped together, and this zip file is password-protected and sent to the recipient's email address(es). Once the email is sent, a trailing email is also sent to the respective email address(es), which contains a 10-character alphanumeric (first five characters are random letters and next five characters are random numbers) password for the zipped PDF and CCD attachment along with the subject name of the previous email for identification. Other Attachment: If the email contains attachment(s) without CCD, then the consolidated PDF file is password-protected. Send: The Send checkbox is automatically selected for all rows when any information (such as Name, Email, Fax, or Address) is entered. Subject: Enter the Subject for the letter in this box. By default, the Subject is set to the selected template name. Note: When Clinical Messaging is enabled in a clinic, on the Letters Out screen a warning is displayed, "Do NOT include private or sensitive information (PHI) in the subject line. It will be displayed in the recipient's personal non-secure email inbox". Also, the option of "Surescripts Directory" is available to users, from which they can select Clinical Messaging recipients. Fax Coversheet: If a coversheet template is defined in the property bizfax.LT.coversheet.template, then the Fax Coversheet option is displayed on the Letters Out screen. If the Fax Coversheet option is selected, the fax is sent with the coversheet; otherwise, the fax is sent without the coversheet. Status: This is set by the system as: Entered: on clicking Save by a user who has been assigned entry rights only. Approved: on clicking Save by a user who has been assigned approval rights. Sent: on clicking Send. Attach Button: Click this button to attach additional file(s) to this letter. Selecting the "Sel" checkbox in the view allows the user to make multiple selections to be attached. Upon selection, the program displays a row of icons, one for each selected document. The user can click any icon to view the contents in a popup or to detach it. Note: Selecting an earlier Letters Out record will not select its attachments. The fax of the letter will include all selected attachments (provided the letter template is PDF-enabled). The letter template will be printed equal to the number of recipients. Deleting the letter will fail if it has been attached to another Letters Out record. If a CCD file is attached, it prints the HTML of the CCD file along with a combined single PDF; if a CCD file is attached, it downloads both XML and HTML discretely. When a user clicks download, the CCD HTML file and CCD XML file are downloaded separately into the same folder. If it is a non-secure email and the user is attaching a CCD file while sending the letter, both the XML and HTML files are sent discretely; If a CCD file is attached while sending the letter, the HTML of the CCD file (after converting to PDF) is sent. If the property mail.attachment.password.protect is turned ON, then it allows the user to send a non-secure mail in the following two ways with a password-protected attachment: CCD Attachment: If the email contains a CCD attachment, then the consolidated PDF and CCD files (XML and HTML files) are zipped together, and this zip file is password-protected and sent to the recipient's email address(es). Once the email is sent, a trailing email is also sent to the respective email address(es), which contains a 10-character alphanumeric (first five characters are random letters and next five characters are random numbers) password for the zipped PDF and CCD attachment along with the subject name of the previous email for identification. Other Attachment: If the email contains attachment(s) without CCD, then the consolidated PDF file is password-protected. Billing Docs: Click this button to attach Billing documents to this letter. This button is present only on the Letters Out screen accessed via Patient → Letters Out and is visible only to those users who have been assigned the LetterBillDocs role from the User Role screen. A popup is invoked on clicking this button which has two options: Patient Ledger and Patient Statement with checkboxes for both options. Select the required type of document and click the OK button on the popup to save the selection and close the popup, or click the CANCEL button to close the popup without saving the changes. The selected documents appear as icons between the Billing Docs button and the Set Sequence icon. The tooltip for the icon displays the document type. On clicking the icon, a popup is invoked which displays the details of the Patient Statement or Patient Ledger documents along with two buttons: detach and close. Users can click the detach button to delete the attached document and remove the icon for that document. On clicking the close button, the popup closes, and the user is redirected to the Letters Out screen. All Billing documents attached via the Billing Docs button as well as EMR documents attached via the Attach button are detached from the letter. Select Tags : To add new contents at any position, move the cursor to that position and click there. Now select any tag from the list box. The program selects the tag, generates the relevant contents, and inserts them at the cursor position. The generated contents can be a small string (like a Patient Name) or a multiple-line string (like a List of Current Medications). The CC list and subject can be printed as part of the letter by using special tags. Use [LETTER_SUBJECT] to print the subject and [LETTER_CC] to print the CC. Letter dropdown list: Displays a list of all letters for the current patient in reverse chronological order. Append: The Append feature on the Letters Out screen enables the user to send multiple letters at a time. To do this: Select a template from the 'Letter' dropdown list. This will be the default template. Click the button next to 'Append'. A new window displays a list of the available templates, from which the user can select multiple templates by clicking the checkboxes against each template name. Click OK to append these selected templates to the default template selected from the 'Letter' list. The multiple letters are separated by page breaks in the body. The user can edit these letters. Note: The letters are displayed in the order that they were selected. The default template is selected from the 'Letter' list. If any other default template is selected, the existing contents are overwritten. The Select Tags and Template options are disabled if the selected patient does not have an encounter. Letter Contents: The text of the letter generated based on the template and the tags used is shown here. The user can add / delete / change the contents. The text editor toolbar provides a wide range of functionality, with standard buttons, tooltips, and features. The user is also allowed to save and send a letter without any content, containing only attachment(s) and/or a Fax Coversheet. During Print, Fax, Email, and Download operations, only the Fax Coversheet and/or attachment content is available to the user. Send: A letter cannot be sent until it is approved by the provider. Once the letter status is "Sent", the user will not be allowed to edit the letter or add attachments, but only view existing attachments. If the letter is sent out to multiple people, then users are able to see multiple entries in the 'Letter To' column of the search available on the Letters Out screen. Save: Click this button to save the changes on the Letters Out screen. In order to save the letter, mandatory fields such as 'To', 'Name', and at least one of the 'Email Address / Fax / Address' fields are required. Delete: Click this button to delete letters that are in 'Sent' status. Only users with the 'DeleteSentLetterOut' role access are allowed to delete sent letters. Reset: Click this button to reset recently entered changes in the record to how they were before saving. Save As: Click this button to create a copy of the letter with the same subject as defined for the original letter. If the original letter has attachments, all attachments are also copied to the new letter. The 'Save As' button is enabled after the first 'Save' action on the Letters Out screen for all users who have access rights to the Letters Out screen. Depending on whether the user has Approve rights for Letters Out, when a copy of a letter is created in Approved status, the new letter is also in Approved status. However, if the user does not have Approve rights, the new letter is created with Entered status. Action icons on Letters Out screen: There are five action icons in the top-right corner of the screen. These icons offer different ways to share the selected letters and documents from this screen via print, fax, email, download, and directly on all PrognoCIS Portals. Print: Click this icon to print the selected letters. Upon closing the print window, the status changes from Approved to Sent, which is displayed as a hyperlink. Clicking the hyperlink invokes the Message Events popup, which displays the Send Type as Print. Fax: Click this icon to fax the selected letters, ensuring that both the sender's and receiver's fax numbers are provided. If the fax number for the selected receiver is absent, an error message will appear stating: Fax number is not present for the selected receiver. After sending the fax, the status transitions from Approved to Sent, which is displayed as a hyperlink. Clicking this hyperlink invokes the Message Events popup, which shows the Send Type as Fax. Password-protected documents cannot be sent via fax from this screen. Clicking this icon for such documents displays an alert message stating: The attached document is password-protected; therefore, it cannot be faxed. Share the encrypted document via email. Email: Click this icon to email the selected letters to the recipients (Provider, Insurance, Employers, Attorney, Adjuster, etc.). If the Email Type is selected as Non-Secured, clicking this icon displays a warning message: Sending patient health data over email is not advisable for HIPAA compliance reasons. Do you want to continue? along with the email addresses. Clicking the OK button on this popup sends two emails to the recipient. One contains the letters in the form of a password-protected attachment, and the other contains the password to open the attachment. If the email address of the sender or receiver is missing, clicking this icon displays an error message: Cannot send as the Email ID of the sender/receiver is missing. Upon successfully sending the email, a message: Letter Sent Successfully is displayed in green and bold font on the screen, and the status changes from Approved to Sent, which is displayed as a hyperlink. Clicking the hyperlink invokes the Message Events popup, which displays the Send Type as Email. When a secure N2N email is sent from the Letters Out screen, it first goes from the sender to Surescripts and then to the receiver. Upon successfully sending the email, a message: Accepted and Delivered to Surescripts. is displayed in green and bold font on the screen, and the status changes from Approved to Sent, which is displayed as a hyperlink. The Message Events popup, invoked by clicking this hyperlink, displays the date and timestamp at which the letter was sent in the Date Time column; the Email column remains blank (as messages do not pertain to any email ID) and the Event Desc column displays the status of the message, such as Delivered to Surescripts, Delivered to Receiver, etc. This message is updated as per the type of response received from Surescripts. Download: Click this icon to download the PDF of the selected letters. The downloaded letters can be found in the Downloads folder of the local machine, depending on its settings. Upon downloading the letters, the status changes from Approved to Sent, which is displayed as a hyperlink. Clicking the hyperlink invokes the Message Events popup, which displays the Send Type as Download. Share on Portal: Clicking this icon invokes the Select Portal popup. This popup displays the Portal names configured for the client. In front of every Portal name, a toggle button is provided. Users can turn the button On for the Portals where the selected documents need to be shared and click the Save button on the popup to share the documents. After selecting the documents to be shared, they must be saved by clicking the Save button at the bottom of the screen. If a user tries to share documents without saving them, clicking the Share on Portal icon displays the message: "Cannot be shared to portals without saving." If there are no portals configured for the user, clicking the Share on Portal icon displays the message: "Not applicable for sharing." Upon successfully sharing the letters on portals, the status changes from Approved to Sent, which is displayed as a hyperlink. Clicking the hyperlink invokes the Message Events popup, which displays the Send Type as Portal. The Employer's name is displayed below the Employer label on the Select Portal popup to indicate which Employer is associated with the letter. The display of the Employer's name on the popup is determined by the admin-level property letter.use.associate.options. If the property is Off, the priority follows this order: Employer associated with the encounter. Employer from Patient Registration. In this case, a Select Employer icon is available next to the toggle, allowing the user to choose a different Employer. Employers from previous encounters. In this case, a Select Employer icon is available next to the toggle, allowing the user to choose a different Employer. No Employers found. In this case, the toggle remains disabled and Off. If the property is On, the priority is based on the option selected through the Associate Letter To icon, as follows: If the Encounter radio button is selected, the above-mentioned priority is followed. If the Case radio button is selected, the priority is as follows: Employer associated with the selected Case Number. If unavailable, then the Employer associated with the Primary Insurance of the selected Case Number. If neither, then the Employer from Patient Registration is shown, and the Select Employer icon is present to change the Employer. If none of the above are found but Employers are linked to previous encounters, then the No Employer Present message displays along with the Select Employer icon to select an Employer. If no Employers are found, then the toggle remains disabled (Off). If the Appointment radio button is selected, the priority is as follows: Employer associated with the Case Number linked to the appointment. If unavailable, then the Employer associated with the Primary Insurance of the selected Case Number. If neither, then the Employer from Patient Registration is shown, and the Select Employer icon is present to change the Employer. If none of the above are found but Employers are linked to previous encounters, then the No Employer Present message displays along with the Select Employer icon to select an Employer. If no Employers are found, then the toggle remains disabled (Off). Note: If the HylaFAX property prognocis.fax.hylafaxapi is turned On from the Properties Master screen, then the documents are sent via the HylaFAX functionality. In this case, the status of the document can be viewed by clicking the Sent hyperlink, which invokes the Status popup. Hint: When Clinical Messaging is enabled in a clinic, on the Letters Out screen a warning is displayed, "Do NOT include private or sensitive information (PHI) in the subject line. It will be displayed in the recipient's personal non-secure email inbox". Also, the option of "Surescripts Directory" is available to users, from which they can select Clinical Messaging recipients. Consider the following conditions with regard to the CCD file: If a CCD file is attached, then on print, it prints the HTML of the CCD file along with a combined single PDF. If a CCD file is attached, then on download, it downloads both the XML and HTML files discretely. When a user clicks download, the CCD HTML file and CCD XML file are downloaded separately into the same folder. If it is a non-secure email and the user is attaching a CCD file while sending a letter, both the XML and HTML files are sent discretely. Fax: If a CCD file is attached while sending a letter, the HTML of the CCD file (after converting to PDF) is sent.