Appointment Scheduling - Technical Specification

Medical appointment booking and management system

Purpose

The Appointment Scheduling module manages the booking, tracking, and coordination of medical appointments for legal case patients. Each appointment must be linked to an authorization, tracked against the legal case, and integrated with provider schedules. The system handles various visit types, manages appointment statuses, and ensures proper authorization utilization while coordinating with claims processing.

Key Concepts

Term	Definition
Appointment	Scheduled medical visit for a patient
Visit Kind	Type of appointment (Initial, Follow-up, Therapy, etc.)
Appointment Status	Current state (Scheduled, Confirmed, Completed, Cancelled)
Authorization Link	Connection to pre-approved authorization
Provider Schedule	Available time slots for providers
Appointment Series	Recurring appointments for ongoing treatment
No-Show	Patient failed to attend scheduled appointment
Reschedule	Moving appointment to different time
Double Booking	Multiple appointments in same slot (controlled)
Appointment Reminder	Automated patient notifications

User Roles

Role	Description	Permissions
Scheduler	Books and manages appointments	Full CRUD
Provider	Views own schedule	Read, Update own
Case Manager	Oversees patient appointments	Read, Create
Patient Coordinator	Assists patients with scheduling	Create, Read, Update
Front Desk	Check-in/check-out	Read, Update status
System Administrator	System configuration	All permissions

Field Documentation - Appointment Entity

Field Name	Type	Required	Description	Validation Rules	Related Entity
ID	String	Yes	Unique appointment ID	Auto-generated CUID	Primary Key
Appointment Number	String	Yes	Human-readable number	Format: APT-YYYY-XXXXXXX	-
Legal Case	LegalCase	Yes	Associated legal case	Must be active case	LegalCase
Patient	Patient	Yes	Patient for appointment	Must match case patient	Patient
MRN	String	Yes	Member Registration Number	From legal case	-
Provider	ClinicalProvider	Yes	Rendering provider	Must be active	ClinicalProvider
Vendor	Vendor	Yes	Provider's vendor	Must be active	Vendor
Location	VendorLocation	Yes	Appointment location	Valid vendor location	VendorLocation
Authorization	Authorization	No	Linked authorization	Must be valid and active	Authorization
Authorization Number	String	No	Auth reference	From authorization	-
Visit Kind	String	Yes	Type of visit	Enum: Initial Eval, Follow-up, Therapy, Procedure, Imaging, Other	-
Visit Type Code	String	No	Specific visit code	Based on visit kind	-
Appointment Date	DateTime	Yes	Date of appointment	Cannot be past for new	-
Appointment Time	Time	Yes	Start time	Valid business hours	-
Duration Minutes	Integer	Yes	Appointment length	15-240 minutes	-
End Time	Time	Yes	Calculated end time	Start + Duration	-
Time Zone	String	Yes	Location time zone	Valid timezone	-
Appointment Status	String	Yes	Current status	Enum: Scheduled, Confirmed, Arrived, In Progress, Completed, Cancelled, No Show	-
Status Reason	String	No	Reason for status	Required for Cancel/No Show	-
Status Changed At	DateTime	No	When status changed	Auto-set on change	-
Status Changed By	User	No	Who changed status	Valid user ID	User
Chief Complaint	String	No	Primary complaint	Max 500 chars	-
Appointment Notes	Text	No	Scheduling notes	Max 2000 chars	-
Clinical Notes	Text	No	Provider notes	Max 5000 chars	-
Diagnosis Codes	String	No	ICD-10 codes	Comma-separated	-
CPT Codes	String	No	Planned procedures	Comma-separated CPT	-
Confirmation Status	String	Yes	Confirmation state	Enum: Unconfirmed, Confirmed, Left Message	-
Confirmation Date	DateTime	No	When confirmed	Set on confirmation	-
Confirmed By	String	No	Who confirmed	Name or system	-
Reminder Sent	Boolean	Yes	Reminder status	Default false	-
Reminder Date	DateTime	No	When reminder sent	Set when sent	-
Reminder Method	String	No	How reminded	Enum: Phone, Text, Email	-
Check In Time	DateTime	No	Patient arrival	Set on check-in	-
Check Out Time	DateTime	No	Patient departure	Set on check-out	-
Actual Start Time	DateTime	No	When provider started	Set by provider	-
Actual End Time	DateTime	No	When provider finished	Set by provider	-
Wait Time Minutes	Integer	No	Calculated wait time	Check-in to Start	-
Is Telehealth	Boolean	Yes	Virtual appointment	Default false	-
Telehealth Platform	String	No	Video platform	Required if telehealth	-
Telehealth Link	String	No	Meeting URL	Required if telehealth	-
Series ID	String	No	Recurring series ID	Links related appointments	-
Series Position	Integer	No	Position in series	1, 2, 3, etc.	-
Total Series Count	Integer	No	Total in series	For recurring appointments	-
Referring Provider	String	No	Who referred	Provider name	-
Referring NPI	String	No	Referrer's NPI	10-digit NPI	-
Transportation Needed	Boolean	Yes	Needs transport	Default false	-
Transportation Arranged	Boolean	Yes	Transport scheduled	Default false	-
Interpreter Needed	Boolean	Yes	Needs interpreter	From patient preference	-
Interpreter Language	String	No	Language needed	Required if interpreter	-
Interpreter Arranged	Boolean	Yes	Interpreter scheduled	Default false	-
Special Instructions	Text	No	Special requirements	Max 1000 chars	-
Copay Amount	Decimal	No	Patient copay	Usually 0 for legal cases	-
Copay Collected	Boolean	Yes	Copay received	Default false	-
Created At	DateTime	Yes	Creation timestamp	Auto-generated	-
Updated At	DateTime	Yes	Update timestamp	Auto-updated	-
Created By	User	Yes	Creating user	Valid user ID	User
Updated By	User	Yes	Updating user	Valid user ID	User
Rescheduled From	Appointment	No	Original appointment	For rescheduled	Appointment
Rescheduled To	Appointment	No	New appointment	For rescheduled	Appointment
Claim	Claim	No	Related claim	After service rendered	Claim

Workflows

Appointment Booking Workflow

1. Patient Selection

   • Select legal case
   • Verify patient information
   • Check case status
   • Review appointment history

2. Authorization Check

   • Lookup active authorizations
   • Verify units available
   • Check authorization dates
   • Select appropriate auth

3. Provider Selection

   • Filter by specialty
   • Check provider availability
   • Verify location
   • Confirm credentialing

4. Schedule Selection

   • View available slots
   • Check for conflicts
   • Consider travel time
   • Select date/time

5. Appointment Creation

   • Create appointment record
   • Link to authorization
   • Decrement auth units
   • Set initial status

6. Confirmation Process

   • Send confirmation to patient
   • Add to provider schedule
   • Create reminder tasks
   • Update case record

Appointment Check-In Workflow

1. Patient Arrival

   • Verify patient identity
   • Confirm appointment details
   • Update arrival time
   • Collect any copay

2. Documentation

   • Verify insurance (if applicable)
   • Update contact information
   • Collect consent forms
   • Note special needs

3. Status Update

   • Change status to "Arrived"
   • Notify provider
   • Calculate wait time
   • Update display board

Appointment Completion Workflow

1. Service Delivery

   • Provider sees patient
   • Document services
   • Enter clinical notes
   • Record CPT codes

2. Check-Out

   • Update completion status
   • Schedule follow-up if needed
   • Provide patient instructions
   • Process paperwork

3. Post-Appointment

   • Update authorization usage
   • Create claim if billable
   • Send notes to case manager
   • Schedule next appointment

Recurring Appointment Workflow

1. Series Setup

   • Define frequency (weekly, biweekly, etc.)
   • Set number of occurrences
   • Choose time slot
   • Link to authorization

2. Series Creation

   • Generate all appointments
   • Assign series ID
   • Check authorization units
   • Block provider schedule

3. Series Management

   • Handle individual cancellations
   • Reschedule within series
   • Track attendance
   • Monitor progress

Business Rules

Scheduling Rules

• Cannot book appointments in the past
• Appointment must be within authorization dates
• Provider must be available at scheduled time
• Location must be open during appointment
• Cannot exceed authorization units

Cancellation Rules

• 24-hour cancellation notice required
• Three no-shows may suspend scheduling
• Late cancellations count as no-show
• Provider cancellations require rescheduling
• Cancelled appointments restore auth units

Authorization Rules

• Appointment requires valid authorization
• Authorization must have units available
• Service type must match authorization
• Provider must match authorization
• DOS auto-approved don't need prior auth

Status Rules

• Status changes must be sequential
• Completed appointments cannot be cancelled
• No-show cannot be changed to completed
• Cancelled appointments can be rescheduled
• Status changes are audited

Integrations

System	Integration Type	Purpose
Authorization System	Direct Database	Auth validation and usage
Provider Management	Direct Database	Provider schedules
Claims Processing	Direct Database	Claim creation
Patient Portal	Web Service	Self-scheduling
Reminder System	SMS/Email	Appointment reminders
Calendar Systems	API	Provider calendar sync
Telehealth Platform	API	Virtual appointments

Common Issues

Issue	Description	Resolution
Double Booking	Same slot booked twice	Conflict resolution workflow
No Authorization	Appointment without auth	Create retroactive auth
Provider Unavailable	Provider called out	Reschedule all appointments
No-Show Pattern	Repeated no-shows	Case manager intervention
Wrong Location	Patient at wrong office	Redirect or reschedule

Screenshots Needed

• Appointment Calendar View
• Appointment Booking Form
• Provider Schedule Grid
• Patient Appointment List
• Check-In Interface
• Series Creation Wizard
• Authorization Selection
• Confirmation Dialog
• Reschedule Interface
• No-Show Report

Performance Considerations

• Calendar must load in < 2 seconds
• Real-time availability updates
• Support 1000+ appointments/day
• Efficient recurring appointment generation
• Quick search across all appointments

Security Considerations

• PHI protection in appointment details
• Provider schedule privacy
• Audit trail for all changes
• Role-based viewing permissions
• Telehealth link security

Notes

• SMS reminders require patient consent
• Telehealth appointments need special setup
• Integration with provider EMRs planned
• Mobile app for scheduling in development