Spravato Center

Spravato Center: turn it on and who can open it

The Spravato Center is one page for a practice’s Spravato (esketamine) and ketamine program: today’s treatment sessions and chairs, every patient from referral and consult to first treatment, the weekly Spravato drug order counted in 56 mg and 84 mg kits, prior authorizations and VA referrals (RFS) that run out before booked sessions, REMS enrollment forms and Patient Monitoring Forms, and visits that still need closing out or billing. It ships off.

1. Turn it on. A practice administrator, or someone allowed to manage additional features, opens Admin > Additional Features, types “Spravato” in Search features, turns on Spravato Center and clicks Save Changes. It adds the Spravato Center page and its toolbar button, a program chip in the patient chart, and Send to patient to sign on the SPRAVATO REMS enrollment form.
2. Open it from the toolbar. Click Spravato Center in the toolbar. Its badge counts what needs the team (authorizations due, REMS forms waiting, overdue monitoring forms, patients to book). You can hide or move the button under Customize your toolbar.
3. Check the program visit types first. The center only counts visits whose visit type is a Spravato or ketamine type. Until someone saves the settings, Hero guesses from your visit type names; an admin should check them in Spravato Center settings.

Across the top of the page, tiles count Sessions today, Onboarding, Authorizations due, REMS waiting, Monitoring forms overdue and Billing issues; click one to jump to its tab. Below them are the tabs Today, Patients, Ordering, Authorizations, REMS and Billing.

Who can open it and change things

Physicians and practice administrators can open the center and change program records. Staff need a permission, given through role profiles or in Admin > Staff / Assistants > the staff member > Access > Customize granular permissions.

Prior authorizations, Forms & Letters and claim details keep their own permissions: marking a renewal sent needs the prior-authorization permission, sending the REMS form needs Forms & Letters, and the Billing tab shows claim details only to people with billing access. Someone without the center permission sees “You don’t have access to the Spravato Center. Ask a practice admin for the ‘Open the Spravato Center’ permission.” While the switch is off, the page says “The Spravato Center is turned off for this practice.”

Spravato Center settings: visit types, drug supply, order window and authorization alerts

Click Settings at the top right of the Spravato Center. The button shows for practice administrators and anyone with the Spravato Center manage permission or the additional-features permission. The settings apply to everyone in the practice.

1. Program visit types: tick which visit types are Spravato and which are Ketamine (“The center counts these visits as Spravato or ketamine sessions.”). A visit type can be in one program only, up to 20 per program. While the note “Hero picked these from your visit type names. Check them and save.” shows, nobody has confirmed them yet.
2. Drug supply: for each program visit type choose Buy and bill, Specialty pharmacy or Not applicable, or leave By payer: VA patients are buy and bill, everyone else uses the specialty pharmacy. Enter the Default specialty pharmacy name.
3. Ordering: Order window (days) is how far ahead the drug order counts booked sessions, 7 to 56 days (28 by default). With Drug inventory on, choose the stock items for the 56 mg kit in Drug inventory and 84 mg kit in Drug inventory so the order reads stock on hand and on order.
4. Authorizations: Flag authorizations ending within (days), 1 to 120 (30 by default).
5. REMS enrollment form: Attach signed paper copies and Notify when a REMS form is signed; see Spravato REMS paper form.
6. Click Save. Hero confirms “Spravato Center settings saved.”

A Spravato patient from referral to treatment sessions and billing

This is how a new Spravato (esketamine) patient moves through the center. Ketamine patients follow the same path without the REMS and specialty pharmacy steps.

1. Add the patient. On the Patients tab click Add patient, or Track on a patient who already has program visits. See Patients and onboarding.
2. Work the onboarding checklist on the program record: labs, medical clearance, benefits checked, authorization, REMS form signed, enrolled on the REMS site, sent to the specialty pharmacy, medication received, first session booked. Move the stage along as you go and leave notes for the provider.
3. Get the prior authorization. Enter it on the patient’s Prior Auth tab; the Authorizations tab then warns before it ends or runs out of units.
4. Enroll the patient in the REMS. Send the SPRAVATO REMS Patient Enrollment Form to sign, fax the signed form, then Mark enrolled with the REMS patient ID. See REMS enrollment and monitoring forms.
5. Book the treatment sessions, for example the induction sessions and then maintenance, with Book as a series on the program record (see Treatment series). Set the patient’s dose (56 mg or 84 mg) so the drug order counts the right kit.
6. Order the drug. Run the Ordering tab before the weekly order: buy-and-bill kits from your own stock, specialty pharmacy kits per patient.
7. Run the session day from the Today tab. Record the dose given and the blood pressure and sedation/dissociation checks during monitoring in the visit’s Medications given in clinic section (see Observation and release), then release the patient.
8. Submit the Patient Monitoring Form on the REMS site within 7 days and mark it on the REMS tab.
9. Close out and bill the visit. The Billing tab lists sessions that still need a signed note, charges or a claim. For how the drug and G2082/G2083 lines are built, see Coding notes.

Today tab: the day’s Spravato and ketamine treatment sessions by chair

The Today tab lists one day’s Spravato and ketamine sessions. When the practice books chairs (resource schedules), they are grouped by chair with the hours booked; otherwise they are a time list. The line under the title counts sessions, checked in, done, no-shows and cancelled.

• Each session shows its time, the patient, the visit status (Booked, Confirmed, Checked in, In visit, Done, No-show, Cancelled), the program and visit type, the provider, the series number (for example Series 3/8), In chair … min once the patient is in the chair, and for Spravato the dose (84 mg · 3 devices, or Dose unknown in amber).
• Flags call out what to fix before the session: Not enrolled in the REMS, REMS enrollment not tracked, Authorization ended, No authorization on file, Authorized sessions run out, Authorization ends soon, Dose unknown, Not checked in (15 minutes after the start) and Observation time is up (the monitoring period after the dose has passed and the patient has not been released).
• Buttons: Open chart and Open in calendar on each session. Use the arrows or the date box to look at another day, and Today to come back.

The Today tab only reads the schedule. Check-in, the dose, blood pressure checks and release happen in the visit as usual.

Patients tab: add a patient to the Spravato or ketamine program and follow onboarding

The Patients tab is the program roster. Choose Spravato or Ketamine, then Onboarding (the default), In treatment, All or Closed. Search by name or MRN, or filter by stage. The strip above the list counts open records per stage: Referred, Consult booked, Consult done, Authorization, REMS enrollment (Spravato only), Pharmacy onboarding, Ready to book, In treatment and On hold.

Columns: Patient, Stage, Days in pipeline, Next session, Next 28 days, Authorization, REMS, PHQ-9, Dose, Supply and Payer. A red triangle marks a safety-priority patient; Nothing booked ahead marks someone with no session booked.

Add a patient to the program

1. Click Add patient and find the patient. Or, for a patient listed as Not tracked (they have program visits but no record yet), click Track.
2. Choose the Program and Stage.
3. Fill in what you know: Date added, Consult date, Provider, Coordinator, Payer, Prior authorization by (Specialty pharmacy or Our practice), Drug supply, and for Spravato the Dose, REMS enrollment and REMS patient ID. Leave a field blank and Hero fills it in from the chart when it can (the payer from the patient’s insurance, the dose from the chart).
4. Tick Safety priority for suicidal ideation, to move the patient to the front of the line.
5. Click Add patient. If the patient already has an open record in that program, Hero offers to open it instead.

Adding patients and changing records needs the manage permission (see Who can open it). Click any row to open the patient’s program record.

The program record: checklist, notes to the provider, close or remove a record

A program record opens from the right when you click a patient on the Patients tab, the chart chip, or the link in an Inbox notification. At the top are the stage (change it from the list), Safety priority, and the counts Days in pipeline, Time to treatment, Sessions booked and Latest PHQ-9.

• Notes and activity: write where things stand and click Add note. Tick Notify with the provider’s name to send them an Inbox notification (set a provider on the record first). Every change to the record is listed here too.
• Checklist: mark each onboarding step Needed, Done or Not needed: Labs, Medical clearance, Benefits checked, Authorization, and for Spravato REMS form signed, Enrolled on the REMS site, Sent to the specialty pharmacy and Medication received, then First session booked.
• Authorizations: the coverage status, end date and sessions booked after it ends. Manage authorizations opens the patient’s Prior Auth tab.
• REMS (Spravato): the REMS status and ID, Start REMS form, Mark enrolled, and where the enrollment form stands.
• Sessions: sessions booked ahead and any treatment series. Book as a series books the course of treatment sessions.
• PHQ-9: the patient’s PHQ-9 scores. For ketamine, Self-pay price shows the price per ketamine visit type.
• This patient’s price (Custom pay). Set this patient's price sets what this patient pays per ketamine visit type (0 means they owe nothing; leave it blank for the practice price), on every provider’s visit type with that name. The price is charged whenever the visit is billed as cash: always for a visit type set to Cash only in the Service Menu (as ketamine infusions usually are), even when the patient has insurance on file, and on any visit type for a cash-pay patient. Saving it also re-prices the patient’s upcoming visits of that type that haven’t been paid, so check-in collects the new price; a price of 0 collects nothing, asks for no card, and charges nothing when the note is signed (a one-time price set at signing still applies). When a visit type is billed to the patient’s insurance instead, the section says so in one line (“KIT - VA is billed to this patient's insurance, so this patient's price isn't charged. It applies when the visit type is Cash only.”). Hero adds no insurance copay to a ketamine visit billed as cash; a copay already on a visit stays until you change or remove it. To fix a copay or a visit fee already charged, see Change or remove a copay.
• Details: the fields from Add patient, including First treatment and the Dose.

Close a record, or remove one added by mistake

1. To end a program record (the patient started, stopped or was not a candidate), click Close record, choose the Outcome (Started treatment, Denied, Lost contact, Patient declined, Not a candidate, Other) and the Outcome date. The record moves to the Closed view.
2. To delete a record added by mistake, click Remove (entered in error), then Remove (“Use this only for a record added by mistake.”). It does not touch the patient’s chart, visits or forms.

Ordering tab: the weekly Spravato drug order in 56 mg and 84 mg kits

The Ordering tab (titled Spravato order) counts every Spravato session still booked in the window as kits, so you know how much esketamine to order: a 56 mg kit has 2 devices, an 84 mg kit has 3. Cancelled, no-show and held visits are left out, and so are doses already given. Run it before you place the weekly order.

1. Pick the window with Starting and For (1 to 8 weeks; the default comes from the order window setting).
2. Read the totals: Sessions, 56 mg kits, 84 mg kits, Devices and Dose unknown.
3. Fix unknown doses. In By patient, click Unknown · set dose to open the program record and set the dose. Hero looks for it on the program record, then the last dose given, then the medication list.
4. Work out what to buy. By drug supply splits the kits into buy and bill and each specialty pharmacy. For buy-and-bill kits it shows On hand (56 / 84), On order (56 / 84) and To order (56 / 84): from Drug inventory when the kit items are chosen in the settings, otherwise type 56 mg kits on hand and 84 mg kits on hand (nothing is saved).
5. Download it with CSV or Excel to send to the pharmacy or distributor.

By week and Appointments (sortable by date, patient or provider) show the same sessions another way.

Authorizations tab: prior authorizations and VA RFS that end before booked sessions

The Authorizations tab lists program patients whose prior authorization, VA referral (RFS) or TRICARE authorization ends, runs short or is missing while sessions are booked, each with one sentence saying what to do (for example “Send the RFS now.” or “Renew it before that session.”). It reads the authorizations on the patient’s Prior Auth tab, and flags them the number of days ahead set in the settings.

• Show: Needs action (the default), All, or one status: Ended, sessions booked, Not covered, Not enough units, Ending soon, Follow-up due, Covered. Filter by program with Both programs.
• Each authorization shows its dates, number, units left, sessions booked after it ends and any follow-up date.

1. Request the renewal or the new RFS with the payer or the VA as usual.
2. Click Mark renewal sent (Mark RFS sent for VA patients). Hero notes it on the authorization and sets a follow-up a week out. This needs the prior-authorization permission.
3. Enter the approval when it comes: Manage authorizations opens the patient’s Prior Auth tab.

REMS tab: Spravato REMS enrollment and Patient Monitoring Forms

Each Spravato patient must be enrolled in the SPRAVATO REMS before the first dose, and the REMS needs a Patient Monitoring Form online within 7 days after every session. The REMS tab follows both. Ketamine has no REMS.

REMS enrollment

Show Not enrolled yet (the default) or All. Columns: Patient, REMS (Not started, Pending, Enrolled), Enrollment form (No form yet, Draft, Waiting for release, Released, Sent to patient to sign, Signed by patient, Faxed) and Next session.

1. Click Start form to start the SPRAVATO REMS Patient Enrollment Form in the patient’s Forms & Letters, then release it.
2. Click Send to patient to sign to send it for signature in the portal. A patient who signs a printed copy at the office: Attach signed copy (see Spravato REMS paper form).
3. Fax the signed form to the REMS from Forms & Letters.
4. Click Mark enrolled and enter the REMS patient ID the REMS site gave the patient (you can add it later).

Patient Monitoring Forms

The Monitoring forms list shows Spravato sessions from the Last 7 days, Last 14 days (the default) or Last 30 days: Session, Patient, Provider, Dose · lot and Form (Due, Overdue or Submitted, with days left or days late).

1. Submit the Patient Monitoring Form on the REMS site.
2. Click Mark submitted on the session. If you marked the wrong one, click Undo.

A form already ticked in the session’s Spravato note block shows Checked in the visit note instead of Marked here.

Billing tab: Spravato and ketamine visits not closed out, unsigned or not billed

The Billing tab (Billing follow-up) lists past Spravato and ketamine visits that still need closing out, a signed note, charges or a claim, one issue each, worst first. Choose the issue (Every issue by default) and the period, the last 7, 14, 30 (default), 60 or 90 days.

Use Open visit and Open claim to fix the visit; the tab itself never changes a charge or a claim. Without billing access you see only visits to close out and unsigned notes (“Billing details need billing access.”). For how Spravato charges are built, see Coding notes.