Ophthalmology

From referral to appointment,
without the manual work.

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01 Referral Intake

Every referral classified the moment it arrives.

Urgent, surgical, diagnostic, and elective referrals are classified automatically. Gaps in documentation are flagged and returned to the referring provider before anything enters the queue.

Urgency classification

Acute cases such as retinal detachment and sudden vision loss are separated from diagnostic workups and elective referrals automatically at intake.

Incomplete referrals handled

Missing documentation triggers an automatic fax-back to the referring provider, specifying exactly what is needed before the referral can be accepted.

Referral Intake Queue Auto-classified
URGENTRetinal detachment · Routed stat
Surgical pre-opCataract · Auth required
DiagnosticOCT imaging · Docs complete
ElectiveRoutine exam · Queued
Prior Authorization · Cataract surgery
✓ Payer identified
✓ Procedure code matched
✓ Auth request populated
✓ Submitted same-day
✓ Status: approved
Denial docs staged for appeal if needed
02 Prior Authorization

Submitted same-day. Tracked automatically.

Authorization requirements identified by payer and procedure code at intake. Requests populated and submitted same-day. Denied auths flagged with supporting documentation staged for appeal.

Automatic identification and submission

Authorization requirements identified by payer and procedure code at intake. Requests populated and submitted same-day for qualifying procedures.

Denial management

Denied authorizations are flagged with supporting documentation ready for appeal, without staff having to rebuild the case from scratch.

03 Eligibility

Every patient verified before a slot is offered.

Benefit pathway determination runs automatically based on diagnosis. Payer-specific documentation requirements enforced before any slot is offered. Out-of-network cases excluded early.

Benefit pathway routing

Vision vs. medical benefit determination runs automatically based on diagnosis. Payer-specific documentation requirements enforced before any slot is offered.

Ineligible cases filtered

Out-of-network and ineligible referrals excluded before entering the scheduling queue.

Benefit Pathway Check
✓ Medical benefitActive · Deductible met
✓ Vision benefitActive · $150 allowance
✕ Secondary payerNot applicable
Correct pathway applied automatically
AI Phone Agent · Outreach call Live
LindaHi, calling from Valley Eye Center to schedule your ophthalmology appointment.
Yes, I got the referral from my doctor.
Your insurance is verified. I have availability Thursday at 10 AM. Do you need any transportation assistance?
Thursday works.
Confirmed. You will receive pre-visit instructions by text. Is there anything else I can help you with?
04 Patient Scheduling

Booked and confirmed. No coordinator required.

After eligibility clears, the agent contacts the patient, schedules the appointment, confirms transportation, and sends procedure-specific pre-visit instructions, all in one call.

AI phone outreach

After eligibility clears, the agent contacts the patient, schedules the appointment, confirms transportation, and sends procedure-specific pre-visit instructions. Every interaction logged directly to the EHR.

05 EHR Integration

Charts built. Documents filed. Ready for approval.

Patient records populated from the referral. Imaging reports, diagnostic records, and insurance documents sorted and uploaded automatically. Staff approve before finalization.

Automated chart creation

Patient records populated from the referral. Imaging reports, diagnostic records, and insurance documents sorted and uploaded automatically.

Human in loop

Staff approve each chart before it is finalized. Oversight without data entry.

Chart Build · Auto-populated
Referral notesUploaded
Imaging reportsUploaded
Insurance docsUploaded
Diagnostic recordsUploaded
Staff reviewPending approval
Ready to get started?

See how TriFetch works for your ophthalmology practice.

Book a Demo → Call Linda · (240) 981-5499