End-to-End Patient Journey Guide — General Psychiatry + Spravato

This guide walks your team through every stage of the patient journey — from first contact through ongoing care. Use it to orient new staff, standardize workflows, and ensure nothing falls through the cracks.

Step 1 — Patient Screening & Intake Inquiry

First contact through eligibility determination

Owner: Front desk / Intake coordinator

Sub-steps:

• Receive inquiry (web form, phone, referral, or patient portal request)

• Conduct brief phone screen: chief complaint, current medications, insurance, and prior psychiatric history

• Confirm the practice treats the patient's presenting condition (e.g., MDD, TRD, anxiety, PTSD)

• If Spravato is a likely treatment path, note TRD criteria upfront (2+ prior antidepressant failures)

• Document inquiry in Osmind and assign status

Key tools: O360 patient chart, intake phone, screening checklist

Step 2 — Patient Registration

Collecting demographics, insurance, and consent

Owner: Front desk / Intake coordinator

Sub-steps:

• Collect full demographics: name, DOB, address, phone, emergency contact

• Assign to New Patients Group to ensure patient receives & completes the required consents

• Capture insurance information: primary payer, member ID, and group number

• Obtain and upload insurance card images

• Create and verify patient record in O360

Key tools: O360 patient registration, patient portal invite

Step 3 — Insurance Verification & Benefits Check

Confirming coverage before the first appointment

Owner: Osmind RCM team / front desk

Sub-steps:

• Automatic eligibility check in O360 once patient insurance info is added

• Confirm active coverage, effective dates, and deductible/copay/coinsurance amounts

• Verify in-network status for the treating provider and the practice's NPI

• Check behavioral health vs. medical carve-out (some plans separate mental health benefits)

• For Spravato patients: verify medical benefit coverage separately — Spravato bills under medical, not mental health

• Document benefits findings in O360 and communicate patient responsibility estimate to patient

Key tools: O360 eligibility tool, Support tab for tickets to RCM

Step 4 — Scheduling

Booking the initial evaluation and establishing the care cadence

Owner: Front desk / Scheduling coordinator

Sub-steps:

• Schedule Initial Evaluation with appropriate provider in Osmind

• Appointment confirmation and any intake/consents/screeners will go out automatically

• Confirm patient has completed all intake paperwork prior to the appointment date

Key tools: O360 scheduling module, patient portal messaging

Step 5 — Initial Psychiatric Evaluation

Clinical assessment and treatment planning

Owner: Provider

Sub-steps:

• Review completed intake paperwork and prior records before the session via the Patient Profile > Charting section

• Conduct structured evaluation (i.e., Initial Eval note template): history, MSE, safety assessment, diagnoses

• Complete validated screening tools as appropriate (PHQ-9, GAD-7, PCL-5, DAST, etc.) in Osmind

• Establish diagnoses and document in clinical note

• Develop treatment plan: medication, therapy, frequency of visits

• If Spravato candidate: document TRD criteria, discuss REMS program, obtain patient consent

• Sign and lock note once complete and ensure CPT/E&M code is selected (typically 90792 for new patient psych eval)

• Schedule follow-up appointments per treatment plan

Key tools: O360 clinical notes, measurement-based care tools, treatment plan builder

Step 6 — Prior Authorization (if required)

Getting payer approval before services are rendered

Owner: Osmind ****RCM team, with clinical support from provider

Sub-steps:

• Submit a ticket via Support to Osmind in order to determine if prior auth is required for psychiatric services (varies by payer and plan)

  • For Spravato: prior auth is almost universally required — initiate immediately after evaluation

• Submit PA request, ensure supporting clinical documentation is in patient’s chart: diagnosis, treatment history, failed medication trials

• Track PA status in O360 > Support

• Osmind will document approval (auth number, date range, approved sessions/units) in billing system

• Osmind will communicate PA outcome to ticket submitter for practice to move forward with scheduling & next steps

• For patients transferring from another clinic: Check if an active authorization already exists with their insurance. If so, document the PA number, approved doses, validity dates, and number of sessions/units approved. This existing authorization can be used for continued treatment without submitting a new PA request.

• If PA is flagged as duplicate: Osmind will check for existing active authorizations on file. If an active authorization already exists, treatment can proceed using that authorization without waiting for the duplicate submission to process.

• For Spravato: Send prescription to specialty pharmacy once PA is approved. Send the Spravato prescription to the payer's designated specialty pharmacy, such as OptumRX for Optum plans. If applicable, include the patient's Spravato withMe Savings Card with the prescription. The specialty pharmacy will contact the patient directly to confirm shipment details.

Key tools: O360 prior auth tracking, payer portals, Cover My Meds (if applicable)

Step 7 — Ongoing Psychiatric Appointments

Follow-up visits and medication management

Owner: Provider + front desk

Sub-steps:

• Schedule follow-up per treatment plan cadence (typically 4 weeks for stable patients, sooner if new medication)

• Provider completes follow-up note in O360 with MSE, medication review, and outcome measures

• Update treatment plan and document any medication changes

• Capture billing codes

• Collection copay/coinsurance at time of service or via patient portal

  • Automatic copay collection coming soon!

• Schedule next appointment before patient leaves

Key tools: O360 clinical notes, scheduling module, RCM billing workflow

Step 8 — Spravato Treatment Sessions

REMS-compliant esketamine administration

Owner: Spravato-certified clinical staff + prescribing provider

Sub-steps:

• Confirm PA authorization is active and covers the scheduled session date

• Verify patient is enrolled in the REMS program (Patient Enrollment Form on REMSConnect)

  • See this article for more information

  • This is practice responsibility

• Complete pre-treatment check: blood pressure, contraindications, current medications, sobriety status

• Administer Spravato nasal spray per protocol (56mg or 84mg per prescriber order) in monitored REMS-compliant setting

• Monitor patient for minimum 2 hours post-dose (REMS requirement): BP checks, dissociation/sedation assessment

• Document clinical encounter using the Spravato Session note in Osmind

  • Once you sign & lock your note, the REMS Patient Monitoring Form is automatically faxed and a copy of the form is saved to the patient’s chart.

• Confirm patient has a safe driver/escort — they cannot drive on treatment days

Key tools: REMSConnect portal, Osmind Spravato treatment note, PA authorization record

Step 9 — Claim Submission & Billing

Clean claim submission to payers

Owner: Provider + Office Staff + Osmind RCM

Sub-steps:

• Review, sign & lock clinical notes in O360 to unlock billing workflow

• Confirm CPT/HCPCS codes, diagnosis codes (ICD-10), and modifiers are accurate

• Create CMS1500 form to draft claim

• Osmind submits claims electronically

• Monitor claim status via the Insurance tab in Osmind: track accepted, rejected, and denied claims

Key tools: Osmind RCM, ERA/EFT enrollment

Step 10 — Patient Collections & Statements

Patient responsibility and payment processing

Owner: Osmind RCM

Sub-steps:

• Auto-apply insurance payment (ERA) to patient account; calculate remaining patient responsibility

• Collect payment via patient portal, credit card on file, or at next appointment

• For Spravato patients: clarify patient cost-sharing for medical benefit claims, which may differ from mental health copays

Key tools: O360 patient billing, patient portal, payment processing integration

Quick Reference: Who Does What