Automated New vs. Established Patient Type Suggestions in Scheduling

Classify Patient During Scheduling

Review or Override Patient Type

Recalculate Patient Type During Appointment Updates

View Saved Patient Type

What’s New

• A new Patient Type field is available across:
  – Book Appointment
  – Follow-Up Scheduling
  – Quick Scheduling
  – Edit Appointment
  – Reschedule Appointment
• The Patient Type field supports New Patient, Established Patient, and Select.
• Once a provider is selected, the system evaluates qualifying encounters from the previous 3 years to generate a suggested Patient Type.
• A qualifying encounter must have reached Checked-Out status or beyond. Scheduled, Checked-In, Cancelled, No Show, and other non-qualifying appointments are excluded.
• Established Patient is suggested when a qualifying encounter exists with:
  – The same provider, or
  – A different provider with the same assigned specialty.
• New Patient is suggested when no qualifying encounter exists within the selected provider’s specialty during the previous 3 years.
• System-generated suggestions are highlighted in green.
• An information icon explains how the Patient Type was determined and can display relevant encounter, provider, and specialty information.
• Users can manually select New Patient or Established Patient at any time.
• Manual selections remove the green system-suggestion highlight, and the information hover identifies the value as manually overridden while retaining the system-determined classification for reference.
• Suggestions automatically recalculate when the provider/resource or relevant patient context changes within scheduling workflows.
• For resource appointments, the linked provider is used to determine the suggestion.
• If no provider is selected, provider specialty information is unavailable, or the system cannot determine a classification, Patient Type remains Select and scheduling is not blocked.
• The saved Patient Type is displayed as read-only information in Scheduler appointment hover details and the Patient Status view.
• The saved Patient Type can also be reflected in the associated Superbill when the corresponding Superbill functionality is implemented.

How It Works 

• Open a supported scheduling workflow and select the patient and provider.
• The system reviews qualifying encounters from the previous 3 years and evaluates them against the selected provider’s specialty.
• Based on the available history, the system suggests New Patient or Established Patient and highlights the suggested value in green.

• Hover over the information icon to review the reason for the suggested classification, including relevant prior encounter information when applicable.

• Accept the suggested value or manually select New Patient or Established Patient.
• If manually overridden, the green highlight is removed and the information hover identifies the selection as a manual override while displaying the system-determined value.
• If the provider or relevant scheduling context changes, the system recalculates the suggestion using the updated information.

• If a suggestion cannot be generated, the field remains Select and users can manually choose the appropriate Patient Type without interrupting scheduling.

• Save or schedule the appointment to retain the selected Patient Type.
• The saved Patient Type can be viewed in appointment hover details across Scheduler views and the Patient Status view.

Benefits

• Reduces the need for schedulers to manually review encounter history when determining New vs. Established status.

• Applies the 3-year qualifying encounter and specialty logic consistently across supported scheduling workflows.

• Supports billing accuracy by capturing Patient Type during scheduling for downstream use, including Superbill workflows when implemented.

• Clearly distinguishes system-generated suggestions from manually selected values.

• Provides transparency through contextual information explaining how each suggestion was determined.

• Preserves user control by allowing manual overrides without blocking appointment scheduling.

• Provides consistent Patient Type behavior across Book, Follow-Up, Quick, Edit, and Reschedule workflows.

Known Behavior / Limitations

• System suggestions require a provider to be selected. Resource-only appointments without a linked provider support manual selection only.

• Provider specialty information must be available for automatic classification.

• Only qualifying encounters that reached Checked-Out status or beyond are considered.

• Automatic recalculation following provider or patient context changes occurs only within scheduling workflows.

• Patient Type displayed in Scheduler and Patient Status hover details is read-only; changes require editing the appointment.

• If the backend classification cannot be determined at load time, Patient Type remains Select without preventing scheduling.

• Superbill reflection depends on implementation of the corresponding Superbill capability.