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

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