Christian Healthcare Centers | Staff Workflow & Automation Guide

Staff Workflow & Automation Guide

Christian Healthcare Centers

Introduction

Purpose

This document provides a clear picture of how the HighLevel automations and integration with Cerbo function in the context of your standard operating procedures and workflows. It explains what starts each workflow, what happens automatically behind the scenes, and when staff involvement is required and by whom.

What This Guide Covers

  • What the workflow does
  • What happens automatically
  • What staff need to do
  • How you’ll know it’s complete

Staff Color Key

Each person or role who receives tasks has their own color in the What Staff Need to Do sections, so you can scan for yours.

  • Daniela
  • Marisa
  • Melissa
  • Mychelle
  • Sheena
  • All Membership Coordinator
  • Appt Provider
  • Medical Assistants
  • Member Services
  • Onboarding
  • Staff

New Inquiries

What This Workflow Does

This is how staff record someone who contacts CHC by phone or in person and is interested in becoming a member, so they’re in HighLevel before they enroll.

The workflow begins when:

What Happens Automatically

When the New Inquiry form is submitted

  • The person is added as a contact in HighLevel.

What Staff Need to Do

Logging an Inquiry

Staff submits the New Inquiry form when someone asks about membership by phone or in person.

How You’ll Know It’s Complete

  • The person has a contact in HighLevel.

Membership Enrollment

What This Workflow Does

This workflow guides new members from the moment they submit the membership enrollment form through payment, the Onboarding Video, and their Cerbo registration and membership agreements. For family memberships, it also makes sure a registration is received for every family member.

It ensures every new member pays their enrollment fee, starts their membership on the date they chose, watches the Onboarding Video, and signs their agreements before care begins, and it involves staff only when follow-up is needed.

HighLevel manages the enrollment, reminders, and the Patient Journey pipeline, and it’s where payment happens and where the membership is managed on an ongoing basis. Cerbo is the medical record, where scheduling, charting, and visit documentation take place.

The workflow begins when either:

Note: Puritan Seminary, sponsored plan, student, and reactivation enrollments follow this same flow. Their sections cover only what’s different.

What Happens Automatically

Once each of the below stages is complete, the patient’s opportunity is automatically created or updated in the Patient Journey pipeline in HighLevel.

When the membership enrollment form is submitted

  • The patient is taken to the order page to pay their one-time enrollment fee.
  • If the fee still hasn’t been paid after a waiting period, staff is notified to follow up.
  • If the patient indicates they’re a former CHC patient, staff is notified to review the request to return, and enrollment pauses until it’s reviewed. If approved, the patient automatically receives an email to continue. If not, they receive an email with the reason staff provided, and the workflow ends.

Once the enrollment fee is paid

  • Staff is notified to charge the patient’s first month, prorated for the days left in the month, and start their monthly subscription, which bills on the 1st.
  • If the patient chose to start on the 1st of next month, their opportunity moves to Awaiting Start Date, and the next steps wait until that date.

On the membership start date

  • The opportunity moves to Need to Watch Onboarding Video.
  • The patient receives a “First Steps” email that confirms their membership is active, explains what to expect next, and links to the Onboarding Video and an optional Onboarding Call.
  • Watching the Onboarding Video gives the patient access to their registration forms. If the video isn’t watched, the patient receives two reminders, and then staff is notified.

After the Onboarding Video is watched

  • The patient receives a short series of emails and texts encouraging them to complete their registration and sign all required membership agreements, for every family member.
  • If the registration and agreements aren’t completed after the full series, a task is created in Cerbo for staff to follow up.
  • For family memberships, reminders continue until registrations are received for all additional family members.

When the registration and agreements are complete

  • Registration reminders stop.
  • The patient’s chart is created in Cerbo as active.
  • Tags are applied, removed, and updated in HighLevel and Cerbo, including preferred location, membership type and payor status, employer (for sponsored plans), and insurance status.
  • Patients who are eligible for Medicare get the Medicare-eligible tag. Patients of Medicare age who aren’t eligible get the Medicare-ineligible tag. Everyone else gets neither.
  • Marisa, Mark, and Melissa receive an email confirming the new membership and its referral source, if there was one.

Note: The Family Membership Non-payor tag means the patient doesn’t need their own payment method on file. If it appears with Needs Pmt Method Added Under Payor, a payment method still needs to be added to the payor’s chart.

If the patient schedules an Onboarding Call

  • On the day of the call, a note is added to the patient’s contact record in HighLevel so staff can document the call.

If the member requests to discontinue

What Staff Need to Do

Enrollment Fee Not Paid

Mychelle receives a task to follow up with patients who submitted the enrollment form but haven’t paid their enrollment fee.

New Sign-ups

Marisa receives a task when a patient pays their enrollment fee. The task shows their start date, prorated amount, and full monthly amount. Charge the prorated first month and start the monthly subscription. The order page tells patients this happens within 24 business hours.

Returning Patient Requests

Marisa receives an email when a former patient asks to return. She reviews the request and completes the Returning Patient Review form, which automatically sends the patient either the approval email or the non-approval email with the reason she provides.

Onboarding Video Not Watched

Mychelle receives a task when a patient still hasn’t watched the Onboarding Video after two reminders. Without it, they can’t reach their registration forms. Check the contact record and reach out if appropriate.

Registration and Agreements Not Completed

Onboarding receives a task in Cerbo to call patients who haven’t completed their registration and agreements after the full reminder series. The task includes the registration form links. For family memberships, Onboarding also receives a task when additional family members haven’t submitted their registrations.

Family Memberships

Melissa receives a task when a family payor signs up. Once every additional family member’s registration is received, remove the Family Registrations Incomplete tag, in HighLevel or Cerbo, so the family stops receiving reminders.

Removing the tag sends Melissa a second task to set up the associations for the entire family. The task includes the Family Group ID.

When someone is added to an existing family membership, Melissa receives a task to end the payor’s current subscription and start a new one, and to set up the new member’s association: open the contact, go to Associations, click Add, select the payor, and choose the Payor label.

Note: The family add-on registration forms are only for adding someone to a family membership that a payor pays for. Never use one for a patient on a sponsored plan. Use the Sponsored Plan forms instead (see Sponsored Plan Employees). An add-on form sets a sponsored patient up as a non-payor on a family membership and leaves their sponsored onboarding stuck.

Onboarding Calls

Staff completes the call and documents the details in the note automatically added to the patient’s HighLevel contact record.

If the Patient Does Not Wish to Continue

Follow the Pt Cancellation steps. For inactivations staff starts, submit the Patient Inactivation form.

How You’ll Know It’s Complete

  • The patient’s chart is active in Cerbo with their membership tags applied.
  • For family memberships, there is no Family Registrations Incomplete tag.
  • For family memberships, every family member is associated with the payor.
  • If an Onboarding Call was scheduled, it’s documented in the HighLevel contact note.

Puritan Seminary Enrollment

What This Workflow Does

This workflow enrolls Puritan Seminary students and their families. They use their own enrollment form and order page, which include Puritan Seminary membership pricing, and then continue through the standard Membership Enrollment workflow.

It ensures Puritan Seminary members are priced correctly and can be identified as Puritan Seminary members from the start.

The workflow begins when:

  • A Puritan Seminary student submits the HighLevel Puritan Seminary membership form, which is used for both individual and family memberships.

What Happens Automatically

When the Puritan Seminary membership form is submitted

  • The patient is marked as a Puritan Seminary student, and the Puritan Member tag is added in HighLevel.
  • The membership is set up as individual or family based on the number of adults and children entered, and the monthly amount is calculated at Puritan Seminary rates.
  • The patient is taken to the Puritan Seminary order page to pay their enrollment fee.

Once the enrollment fee is paid

  • The patient continues through the standard Membership Enrollment workflow, including the start date, Onboarding Video, and registration steps.

What Staff Need to Do

Nothing beyond the standard Membership Enrollment steps. Marisa receives the same sign-up task to charge the first month and start the subscription.

How You’ll Know It’s Complete

  • The patient’s chart is active in Cerbo, and they have the Puritan Member tag in HighLevel.

Student Membership

What This Workflow Does

This workflow handles student memberships for full-time undergraduate college and technical school students, whether they have their own individual membership or are part of a family membership. It collects proof of enrollment when the student joins, then asks them to reverify before each semester.

Students enroll and pay at the regular rate first. Once their eligibility is approved, the student rate starts at the next billing date.

It ensures only eligible students receive student pricing, and that a student who is no longer eligible is moved to the adult rate at the next billing date.

The workflow begins when either:

  • A patient indicates at enrollment that they’re a full-time student, or that their family membership includes one.
  • An existing member submits the HighLevel Student Eligibility Submission form to request the student rate.

Note: Student enrollments otherwise follow the standard Membership Enrollment workflow.

What Happens Automatically

Once the enrollment fee is paid

  • The student is sent the Student Eligibility Submission form to upload proof of enrollment.

When the Student Eligibility Submission form is submitted

  • Any pending semester reminders stop.
  • Staff is notified to review the submission, with instructions for a new student or a returning student, on an individual or family membership.

When staff sets the student’s eligibility

  • If the student is approved for the spring semester, they’re emailed in late July to submit documentation for fall by August 15. If approved for fall, they’re emailed in late November to submit documentation for spring by December 15.
  • If the student hasn’t reverified, staff is notified five days after the deadline, on August 20 or December 20.
  • If the student is marked No Longer Eligible, the reminders end.

What Staff Need to Do

New Student Submissions

Melissa receives a task to review the documents a new student uploaded.

  • If they support a student membership, set the Student Eligibility field, update the person-type counts, and switch the subscription to student pricing starting at the next billing date. For a family membership, the counts and subscription change on the payor’s record.
  • If they don’t, contact the patient. No further action is needed until they become eligible.

Semester Reverification

Melissa receives a task when a returning student submits new documents, and another if a student doesn’t reverify by August 15 or December 15.

  • If the documents support continuing, set Student Eligibility to the new semester’s approval.
  • If not, either give leeway by contacting the patient and changing nothing yet, or remove the student discount: set Student Eligibility to No Longer Eligible, update the person-type counts, and switch the subscription to the adult rate starting at the next billing date.

How You’ll Know It’s Complete

  • Student Eligibility shows the current semester’s approval.
  • Or, Student Eligibility is No Longer Eligible, and the membership is billed at the adult rate.

Reactivation

What This Workflow Does

Former patients who are approved to return are charged either the enrollment fee or a reactivation fee, depending on the review outcome. Once they pay, their membership is reactivated and they go through onboarding again.

It ensures returning patients pay the right fee, are followed up with if they don’t, and complete current forms and the Onboarding Video, even if they completed them before.

The workflow begins when:

Note: How a former patient’s request reaches staff for review is covered in Membership Enrollment.

What Happens Automatically

Once each of the below stages is complete, the patient’s opportunity is automatically updated in the Leads pipeline in HighLevel.

When the request is approved

  • The opportunity moves to Contacted.
  • The patient is emailed to pay their enrollment fee or reactivation fee, starting either today or on the 1st of next month.

If the fee isn’t paid

  • After a day, staff is notified to follow up.
  • After a month, the opportunity moves to Long-term nurture.

Once the fee is paid

  • The patient continues through the standard Membership Enrollment workflow: staff is notified to charge the first month and restart the subscription, and the patient receives the Onboarding Video and registration emails on their start date.

What Staff Need to Do

Approving a Returning Patient

Marisa chooses whether to approve the patient with the enrollment fee or with a reactivation fee on the Returning Patient Review form. If no outcome is submitted within four days, she’s notified again.

Fee Not Paid

Mychelle receives a task to follow up with patients who were approved but haven’t paid their fee.

Restarting the Membership

Marisa receives the same sign-up task as a new member, to charge the prorated first month and restart the monthly subscription.

How You’ll Know It’s Complete

  • The patient’s chart is active in Cerbo with their membership tags applied.
  • Or, the opportunity is in the Long-term nurture stage of the Leads pipeline.

Analog Signup

What This Workflow Does

This workflow enrolls patients who decline to sign up digitally. Staff completes the enrollment and registration forms on the patient’s behalf, using paper membership agreements, and the patient then continues through the standard Membership Enrollment workflow.

It ensures these patients are enrolled, registered, and paid the same way as everyone else, and that their paper agreements are confirmed before the signup is considered complete.

HighLevel holds the staff forms and takes the enrollment fee payment. Cerbo is where the patient’s chart is created and where staff confirm the paper agreements were received.

The workflow begins when:

What Happens Automatically

When the Analog Member Registration form is submitted

  • The patient’s Cerbo chart is created right away, before payment and the paper agreements may have been confirmed.
  • The Membership Agreements Needed (Analog Signup) tag is applied in Cerbo, so staff know to confirm the paper agreements were received.
  • Because staff completed the registration, the patient doesn’t receive registration reminders.

After the enrollment fee is paid

  • The patient continues through the standard Membership Enrollment workflow. They still receive the email to watch the Onboarding Video, and staff is notified if they don’t watch it.

What Staff Need to Do

If a Patient Declines to Sign Up Digitally

  • Have the payor and every additional family member complete their paper membership agreements.
  • Complete the Analog Pre-registration Membership Information form once per family, using the payor’s information.
  • When redirected, complete the Analog Member Registration form for the payor first.
  • Continue through the redirects, completing one Analog Member Registration form for each additional family member.
  • After the final registration, you’ll be redirected to the Analog Enrollment Fee form. Select the same start date chosen in the first step.
  • On the order page, enter the payor’s name and email exactly as they were entered in the first step, then the payor’s card, to pay the enrollment fee.

Paper Agreements

Staff removes the Membership Agreements Needed (Analog Signup) tag in Cerbo once all paper membership agreements have been received.

Onboarding Video

Analog patients still need to watch the Onboarding Video. If they won’t watch it at home, Staff can have them watch it on the office iPad. If that isn’t possible, send them to Mychelle to cover it in an onboarding call.

How You’ll Know It’s Complete

  • The patient’s chart is active in Cerbo, and there is no Membership Agreements Needed (Analog Signup) tag.

Abandoned Cart Nurture (New Purchase)

What This Workflow Does

This workflow follows up with new potential patients who tried to purchase a membership but didn’t complete payment. It sends automated reminders to come back and finish checkout, and stops as soon as the payment goes through.

It ensures interested patients get a gentle nudge to finish enrolling, without staff needing to follow up.

The workflow begins when:

  • A new patient’s signup payment fails in HighLevel.

What Happens Automatically

When the signup payment fails

  • The patient receives a short series of emails and texts over several days, reminding them to return and complete their membership purchase.

If the patient completes payment at any point

What Staff Need to Do

Nothing.

How You’ll Know It’s Complete

  • The patient has completed their purchase and has an opportunity in the Patient Journey pipeline.
  • Or, the reminder series has ended without a completed payment.

Patient Information Corrections

What This Workflow Does

This is how staff correct a patient’s date of birth or change their membership start date after they’ve enrolled. One form updates the patient’s HighLevel contact, their Cerbo chart when applicable, and any workflows that rely on that information.

The workflow begins when:

What Happens Automatically

When a corrected date of birth is submitted

When an updated membership start date is submitted

  • The patient’s start date is updated, and their onboarding adjusts to the new date.
  • If the patient has already paid, staff is notified to adjust their billing for the new start date.

What Staff Need to Do

Submitting a Correction

Staff enters the patient’s email address so the system knows which patient to update, then fills in only the fields that need to be corrected.

  • Corrected Date of Birth: only when a date of birth is already on file.
  • Updated Membership Start Date: any time after the enrollment fee has been paid.

Note: If the patient has the Shared Email tag, don’t submit this form. Task Laura instead. See Patient Email Handling.

Date of Birth Updates

Melissa receives a task to update the patient’s date of birth when a corrected date of birth is submitted.

New Start Date Billing

Marisa receives a sign-up task when a paid patient’s start date changes, to adjust their billing to the new date.

How You’ll Know It’s Complete

  • The corrected information shows on the patient’s HighLevel contact and Cerbo chart.

Appointment Notices

What This Workflow Does

This workflow automatically sends appointment confirmations and reminder texts to patients for their scheduled visits. It keeps patients informed well ahead of their appointments, reduces no-shows, and adjusts automatically when an appointment is canceled or rescheduled.

Cerbo is where appointments are scheduled. HighLevel picks up each appointment from Cerbo and sends the texts.

The workflow begins when:

  • An appointment is scheduled in Cerbo.

Note: Appointments must be booked and canceled in Cerbo, and the workflow picks up the changes automatically, usually within 15 minutes. Never edit an existing appointment. To reschedule, first cancel the original appointment, then create a new one for the new date and time.

What Happens Automatically

When an appointment is scheduled in Cerbo

  • The patient receives a confirmation text.

Before the appointment

  • Reminder texts are sent 3 months, 1 month, and 1 week before the appointment.
  • All appointment notices are sent at 9:15 AM on weekdays.

If the appointment is canceled or rescheduled

  • All reminders for that appointment stop.
  • If it’s rescheduled, reminders start again based on the new date.

What Staff Need to Do

If a Patient Cancels or Can’t Attend

Staff updates the appointment status to Cancelled, or Late Cancelled if it falls within the late cancellation window.

If a Patient Needs to Reschedule

Staff first cancels the original appointment, then creates a new appointment for the new date and time. Don’t edit the existing appointment.

If You’re Unsure

Leave the appointment unchanged and ask for guidance.

How You’ll Know It’s Complete

  • The appointment has taken place.
  • Or, the appointment status is Cancelled or Late Cancelled in Cerbo.

Common Mistakes to Avoid

Deleting Appointments or Using Other Statuses

Don’t delete appointments or change them to any status other than Cancelled or Late Cancelled. Appointments are tied to reporting, patient history, the automations, and the Cerbo integration, so removing them or using other statuses can stop reminders from working correctly.

Editing an Existing Appointment

Never change the date, time, or any other details of an existing appointment. To reschedule, first cancel the original appointment, then create a new one.

Lab Order Notifications

What This Workflow Does

This workflow makes sure labs are ordered and communicated to patients ahead of their Adult Annual Wellness Visit (CPE) or New Patient Adult Annual Wellness Visit (CPE). It prompts the provider to order labs at the right time and sends the patient clear instructions, so lab work is done before the appointment.

It reduces last-minute scrambling and incomplete lab work before CPEs.

The workflow begins when:

  • An Adult Annual Wellness Visit (CPE) or a New Patient Adult Annual Wellness Visit (CPE) is scheduled in Cerbo.

Note: Appointments must be booked and canceled in Cerbo. Never edit an existing appointment. To reschedule, first cancel the original appointment, then create a new one.

What Happens Automatically

Three weeks before the scheduled CPE

  • A task is created in Cerbo for the provider scheduled for the visit, prompting them to order the patient’s labs.

Note: If the CPE is scheduled less than three weeks ahead, the task is created as soon as the appointment is scheduled.

When a Labs Ordered tag is added

  • The patient receives a text and an email explaining that their lab order has been sent, whether fasting is required, and that labs should be completed at least 5 days before their appointment.
  • The tag is removed automatically once the messages are sent.

If no Labs Ordered tag is added within 21 days

  • The workflow stops waiting, clears the lab tags, and the patient doesn’t receive lab instructions.

What Staff Need to Do

Lab Orders

Appt Provider receives a task in Cerbo to order labs for the upcoming CPE, and adds the applicable lab order to the patient’s chart as usual.

Tagging the Chart

Once labs are ordered, Staff adds the correct tag to the patient’s Cerbo chart based on fasting requirements: Labs Ordered - Fasting or Labs Ordered - Non-fasting. Adding the tag is what sends the patient their instructions.

How You’ll Know It’s Complete

  • The lab order is visible in the patient’s open orders in Cerbo, and there is no Labs Ordered tag on the chart.

Rx Notifications

What This Workflow Does

This workflow lets patients know as soon as their prescription has been sent. It gives them immediate confirmation and clear next steps, without staff needing to message them.

The workflow begins when:

  • Staff adds the Rx Sent tag to the patient’s chart in Cerbo.

What Happens Automatically

When the Rx Sent tag is added

  • The patient immediately receives a text letting them know their prescription has been sent, and to check with their pharmacy for status updates or next steps.
  • The tag is removed automatically once the text is sent.

What Staff Need to Do

Prescriptions

Staff adds the Rx Sent tag in Cerbo after the prescription has been sent.

How You’ll Know It’s Complete

  • The prescription has been sent, and there is no Rx Sent tag on the chart.

Referral Management

What This Workflow Does

This workflow keeps patients and staff informed throughout the referral process. It sets expectations up front, updates the patient when action is needed, and clearly tells them when their referral has been sent.

Every referral moves through the same statuses, in order, though not every referral uses every step: New Request, Missing Provider Info (Hold), Verify Eligibility / Insurance, Missing Pt Info (Hold), Waiting for Insurance Authorization, and Referral Sent. The Referral Management form is how staff move a referral forward at each step and keep the patient and other staff informed.

The workflow begins when:

  • A referral is ordered in Cerbo.

What Happens Automatically

When a referral is ordered in Cerbo

  • Shortly after the referral is added to the chart, the patient receives a Referral FAQ email explaining how referrals work at CHC and what to expect next.
  • A status tag is added in Cerbo, numbered Referral 1 through 4, starting with Referral 1 Status: New Request. The tag note shows the full referral order name, so it’s clear which referral each tag belongs to when a patient has more than one.

When staff submits the Referral Management form

  • The referral’s status tag is updated in HighLevel and Cerbo.
  • For Missing Provider Info (Hold), Verify Eligibility / Insurance, and Waiting for Insurance Authorization, the workflow holds until the next status update.

If information is needed from the patient

  • When the status is Missing Pt Info (Hold), the patient receives an email asking for the needed information.
  • If they don’t respond, reminders are sent weekly by email and text until the information is received.

When the referral is sent

  • The patient immediately receives an email and a text confirming the referral was sent, with the name and number of the referred office.
  • The messages explain that the referred office will usually contact them to schedule, and that if they don’t hear back within 7 business days, they should contact that office directly.
  • The referral’s tags are removed automatically two weeks later.

What Staff Need to Do

Updating a Referral’s Status

Staff submits the Referral Management form every time a referral’s status changes after it’s ordered, choosing the referral number and one of: Missing Provider Info (Hold), Verify Eligibility / Insurance, Missing Pt Info (Hold), Waiting for Insurance Authorization, or Referral Sent. That one submission updates the status in HighLevel and Cerbo and sends the patient the right message.

When the Patient Provides Missing Information

Staff removes the referral’s Missing Pt Info (Hold) tag in Cerbo. This moves the referral forward and stops the “info needed” reminders.

Note: All other referral tags are removed automatically as the referral moves forward.

How You’ll Know It’s Complete

  • The referral’s status tag in Cerbo shows Referral Sent, and the patient has received their confirmation.

Common Mistakes to Avoid

Not Setting the Plan Class on the Referral Order

The referral must be set to “referral” as the plan class in the Orders database, or it won’t start this workflow. You can tell by the background color of the open order: white means it isn’t set up, and seafoam green means it is.

Forgetting to Remove the Missing Pt Info (Hold) Tag

Once the patient provides the information, remove the tag in Cerbo. If it’s left on, the patient keeps receiving “info needed” reminders after they’ve already responded.

Choosing the Wrong Referral Number

Each referral is tracked by number, 1 through 4. Use the tag note on the referral’s status tag to confirm which number matches which referral order before submitting the form, especially when a patient has more than one.

Updating a Status Without Submitting the Form

Status changes must be recorded with the Referral Management form, not just in a chart note. Without the form, the patient doesn’t get updates, other staff can’t see the status, and the workflow doesn’t move forward.

Patient Email Handling

What This Workflow Does

Every patient needs their own, unique email address on file. Email addresses cannot be shared with any other patient or contact. HighLevel uses the email address to connect each patient to their Cerbo chart, so a patient without one can miss automated messages and workflows. This section covers how staff change a patient’s email address and what happens when a patient won’t provide one.

It ensures every patient can be reached, stays connected to the right Cerbo chart, and still gets the care and follow-up they need if they don’t use email.

Cerbo is where staff change a patient’s email address, and HighLevel picks up the change automatically. HighLevel also creates contacts with a placeholder email for patients who decline to give one.

The workflow begins when either:

Note: Bounced emails and unsubscribes are handled by the Contact Reachability Alerts workflow. A new email address for a patient moving off a family membership is collected by the Adult Membership Transition workflow.

What Happens Automatically

When staff changes an email address in Cerbo

  • The new address updates automatically in HighLevel. Nothing else is needed.

When the Email Refusal form is submitted

  • The patient is created as a HighLevel contact with a placeholder email address, so they can still go through internal workflows and receive texts.
  • The patient’s Cerbo chart is created, with their membership and location tags, and they’re added to the Patient Journey pipeline as an active patient.
  • Once the chart exists, the Email Refused tag is added in both HighLevel and Cerbo, so these patients are easy to identify.
  • The patient doesn’t receive emails. Any step that depends on an email reaching the patient has to be handled manually by staff.

What Staff Need to Do

Changing a Patient’s Email Address

Staff changes the email in Cerbo. HighLevel updates automatically.

Note: The Patient Email Update Form is for parents and patients during the 18-year-old transition, so staff don’t need to submit it.

If a Patient Declines to Provide an Email Address

Staff creates the patient’s contact using the Email Refusal Patient Creation form, then handles anything that would normally go out by email.

If a Patient Has the Shared Email Tag

This patient still shares an email address with another patient. No one, staff or patient, should submit any HighLevel form for this patient until they have their own email address. HighLevel matches form submissions by email, so the submission would update the other patient’s record.

Continue to make every effort to get a unique email address. Once obtained, change it in Cerbo, then remove the Shared Email tag.

Email Updates From the 18-year-old Transition

Member Services at the patient’s location receives a task in Cerbo to update the patient’s email to the new address shown in the task. The rest of the transition is covered in Adult Membership Transition.

How You’ll Know It’s Complete

  • The patient’s own email address is in Cerbo and matches HighLevel, and there is no Shared Email tag on the chart.
  • Or, the patient has the Email Refused tag in Cerbo and HighLevel.

Common Mistakes to Avoid

Creating a No-email Patient Directly in Cerbo

Always use the Email Refusal Patient Creation form. The form gives the patient a placeholder email address, which is what lets them have a HighLevel contact, receive texts, and go through workflows.

Contact Reachability Alerts

What This Workflow Does

This workflow watches whether CHC can reach each patient by email and text. When a communication problem is detected, it alerts staff so the contact information can be reviewed and updated.

It keeps patients from silently missing important messages about appointments, billing, referrals, or care.

HighLevel detects the problem and alerts staff. Cerbo is where staff correct the patient’s email address or phone number, and HighLevel picks up the change automatically.

The workflow begins when either:

  • An email to the patient bounces.
  • The patient unsubscribes from email.
  • The patient’s phone number is invalid.
  • The patient’s phone number can’t receive text messages.

What Happens Automatically

When a reachability problem is detected

  • Staff is notified in HighLevel, naming the specific problem.
  • If the email bounced or the patient unsubscribed, the Emails Bounce or Unsubscribed tag is added in HighLevel and Cerbo.

Note: This workflow doesn’t resolve itself. Staff action is needed to restore communication with the patient.

What Staff Need to Do

Reachability Alerts

Melissa receives a task in HighLevel for every reachability alert.

  • Review the patient’s record to identify the problem.
  • If needed, follow up with the patient for a corrected email address or phone number.
  • Change the email address or phone number in Cerbo. HighLevel updates automatically.
  • Once the patient gives an updated email address, remove the Emails Bounce tag.
  • Remove the Unsubscribed tag only if the patient asks to receive emails again.

How You’ll Know It’s Complete

  • The patient’s email address or phone number has been corrected or confirmed in Cerbo, and there is no Emails Bounce tag on the chart.
  • Or, the patient has unsubscribed and keeps the Unsubscribed tag.

Medicare Opt-out & ABNs

What This Workflow Does

This workflow handles Medicare compliance on an ongoing basis. It tracks Medicare eligibility, makes sure the Medicare Waiver Agreement is signed and re-signed every year, and collects Advance Beneficiary Notices (ABNs) before visits that require them, notifying staff only when action is needed.

It runs in the background for all active patients and responds automatically to changes in eligibility, agreement status, and upcoming appointments.

The workflow begins when either:

  • An active patient approaches age 65.
  • Staff adds the Medicare-eligible tag for a patient under 65 who has Medicare.
  • A patient with the Medicare ABNs Required tag schedules an appointment with Dr. Rusk or Dr. Lockstadt, the providers who have not opted out of Medicare.

What Happens Automatically

When a patient who isn’t yet Medicare-eligible reaches age 64

  • Staff is notified to mail the Medicare Pre-eligibility Notice letter.

Once a patient becomes Medicare-eligible

  • The Medicare-eligible and Medicare Waiver Agreement Needed tags are added to the chart.
  • The patient receives a series of emails and texts asking them to complete the Medicare Waiver Agreement.

If the Medicare Waiver Agreement isn’t completed

  • Staff at the patient’s location receive a task in Cerbo to call the patient.
  • The reminders and call tasks repeat each week until the agreement is completed.

When the Medicare Waiver Agreement is submitted

  • All reminders and call tasks stop, and the Medicare Waiver Agreement Needed tag is removed.
  • One year later, if the patient is still active, the process starts again so they re-sign the agreement.

Before an appointment that requires an ABN

  • Starting two weeks before the appointment, the patient receives a series of emails and texts asking them to complete the Medicare ABN.
  • The requests continue until the ABN is submitted or the appointment takes place.

If the ABN is still missing the day before the appointment

  • The ABN Missing for Appt tag is added to the chart, so staff know to have the patient complete the ABN at check-in.
  • The tag is removed automatically the day after the appointment.

Note: Appointments must be booked and canceled in Cerbo. Never edit an existing appointment. To reschedule, first cancel the original appointment, then create a new one.

What Staff Need to Do

Patients Under 65 With Medicare

If a patient under 65 tells you they have Medicare, Staff adds the Medicare-eligible tag to their chart in Cerbo.

Medicare Pre-eligibility Notices

Sheena receives a task in Cerbo to mail the Medicare Pre-eligibility Notice letter when a patient turns 64.

Medicare Waiver Agreement Calls

Member Services at the patient’s location receives a task in Cerbo to call the patient when the Medicare Waiver Agreement hasn’t been completed. The task includes the form link.

Patients Who Need ABNs

If a patient has straight Medicare or a Medicare supplemental PPO, Staff adds the Medicare ABNs Required tag in Cerbo. If this no longer applies, remove the tag.

On the Day of the Appointment

If the ABN Missing for Appt tag is on the chart, Staff makes sure the patient completes the ABN at check-in.

How You’ll Know It’s Complete

  • For patients with the Medicare-eligible tag, there is no Medicare Waiver Agreement Needed tag on the chart.
  • There is no ABN Missing for Appt tag on the chart.
  • Or, if the ABN Missing for Appt tag was there on the appointment day, the ABN was completed at check-in.

Turning 2

What This Workflow Does

This workflow watches for young children on a membership as they approach the age when their membership rate changes, and tells staff ahead of time so billing can be adjusted.

It ensures the change happens on time, without staff needing to track birthdays.

The workflow begins when either:

  • A child’s registration and agreements are completed.
  • A child’s date of birth is corrected.

What Happens Automatically

If the child is approaching the rate change

  • Three weeks before the child turns 25 months, staff is notified to adjust the family’s subscription billing. The rate changes the month after the child turns 2.
  • If the date is more than a year away, the workflow keeps watching until it’s within a year.

If the patient is no longer active

  • The workflow ends without notifying staff.

What Staff Need to Do

Subscription Adjustments

Melissa receives a task to adjust the family’s subscription billing for the child’s new rate. The task includes the Family Group ID.

How You’ll Know It’s Complete

  • The family’s subscription reflects the child’s new rate.

Adult Membership Transition

What This Workflow Does

This workflow manages the legal and operational transition of adult children on a family membership, when they turn 18 or later if they are already over 18, so they can consent to their own care. It makes sure the patient has their own email address, moves communication from the parent to the patient, asks the patient to complete their adult consents and registration, and moves their billing to an individual membership.

The rate change takes effect at the next bill date after the 18th birthday, whether or not the patient has signed. Until they sign, they stay on the family membership at the adult rate. There is no enrollment or registration fee for the transition. This applies to adult children only, not spouses or other adults.

The workflow begins when either:

  • A child’s registration and agreements are completed.
  • A child’s date of birth is corrected.
  • Staff starts the transition for a patient who is already over 18.

What Happens Automatically

Ten days before the 18th birthday

  • Staff is notified to adjust the family’s subscription billing.
  • The parent or guardian is emailed and texted to provide an email address of the patient’s own, using the Patient Email Update Form.
  • If they don’t respond, staff is notified to call them.

When the patient’s new email address is provided

  • If the parent or guardian uses the Patient Email Update Form, the email on the patient’s HighLevel contact is updated, and staff at the patient’s location receive a task to update it in Cerbo.
  • If staff changes the email in Cerbo, HighLevel picks up the change automatically, and no task is sent.

On the 18th birthday, or once the new email address arrives if that’s later

  • The adult form tags, including Adult Consents Needed, are added to the chart.
  • The patient is emailed and texted to complete their adult consents and registration on the Registration & Agreements - 18-year-old Transition, Payor form.
  • If they don’t complete it, staff at the patient’s location are notified to call them, and the reminders repeat until it’s done.

When staff starts the transition for a patient already over 18

  • Staff is notified to adjust the family’s subscription billing.
  • The parent or guardian is not contacted. Staff collects the patient’s email address before starting the transition.
  • The patient receives the same adult consents and registration reminders and the same monthly membership reminders, worded for a patient who is already over 18. Calls, completion, and everything else work the same way.

Each month until the transition is complete

  • Starting on the 20th, the patient receives a series of reminders to set up payment for their individual membership.
  • If it’s still not complete, staff is notified.

When the patient completes the form

  • The consents and registration reminders stop, and the transition tags are removed.
  • On the form, the patient chooses whether a parent or guardian should keep access to their health information. If they want a parent or guardian to have access, the Guardian Access Pending tag is added until they complete the release in Cerbo. If not, the Guardian Access Denied tag is added.
  • If the patient asked to update their portal login, staff at their location receive a task to do it.
  • Staff is notified to start the patient’s individual subscription and remove them from the family’s subscription.

When the patient sets up payment for their individual membership

  • The monthly membership reminders stop.

What Staff Need to Do

Starting the Transition for a Patient Already Over 18

The transition starts on its own for patients turning 18. For an adult child who is already over 18 and still on a family membership, Staff starts it, in this order:

  1. Get the patient’s own email address from the patient.
  2. Change the email in Cerbo, then check that the new address shows on the patient’s HighLevel contact. If the chart has the Shared Email tag, remove it once the new address is in Cerbo.
  3. Add the Adult Transition Start tag to the patient’s contact in HighLevel.

Note: Don’t add the tag until the new email address shows in HighLevel. If the tag goes on first, the patient’s messages go to the old address.

Subscription Adjustment

Melissa receives a task to adjust the family’s subscription billing, either 10 days before the patient turns 18 or when the transition is started for a patient already over 18. The task includes the Family Group ID.

Getting the Patient’s Email Address

All Membership Coordinator receives a task in Cerbo to call the parent or guardian if they haven’t provided the patient’s new email address. Once they have it, they change the email in Cerbo.

Member Services at the patient’s location receives a task in Cerbo to update the patient’s email to the new address shown in the task, when the parent or guardian provided it on the Patient Email Update Form.

Adult Consents

Member Services at the patient’s location receives a task in Cerbo to call the patient if they haven’t completed their adult consents. Check the task history, since they may already have been called.

Moving to an Individual Membership

Melissa receives a task when the patient completes the form, to schedule their individual subscription, reduce the family’s subscription by one child, and remove the patient’s association with the family. She also receives a monthly task if the patient still hasn’t completed the move.

Parent or Guardian Access

Once the patient completes the release in Cerbo, Staff removes the Guardian Access Pending tag and adds the Guardian Access Approved tag, listing the approved person in the tag note.

If the chart has the Guardian Access Denied tag, the patient’s health information must not be released to a parent or guardian.

Portal Login Updates

Member Services at the patient’s location receives a task in Cerbo to update the patient’s portal login, if they asked for a change on the form.

How You’ll Know It’s Complete

  • There is no Adult Consents Needed or Adult Membership Transition Incomplete tag on the chart.
  • The chart has either the Guardian Access Approved or Guardian Access Denied tag.
  • The patient has their own individual membership, and the family’s subscription no longer includes them.
  • The patient is no longer associated with the family’s payor.

Turning 65

What This Workflow Does

This workflow watches for adult members as they approach age 65, when their membership moves to the senior rate, and tells staff ahead of time so billing can be adjusted.

It ensures the change happens on time, without staff needing to track birthdays.

Note: Medicare eligibility, which also begins at 65, is tracked separately in Medicare Opt-out & ABNs.

The workflow begins when either:

  • A patient’s registration and agreements are completed.
  • A patient’s date of birth is corrected.

What Happens Automatically

Three weeks before the 65th birthday

  • Staff is notified to adjust the patient’s subscription billing to the senior rate. For a family membership, the task asks staff to remove one adult and add one senior.
  • If the birthday is more than a year away, the workflow keeps watching until it’s within a year.

If the patient is no longer active, or is already 65

  • The workflow ends without notifying staff.

What Staff Need to Do

Subscription Adjustments

Melissa receives a task three weeks before the patient turns 65 to move their billing to the senior rate. For a family membership, the task includes the Family Group ID and asks her to remove one adult and add one senior.

How You’ll Know It’s Complete

  • The patient’s subscription is billed at the senior rate.

Amish Patients

What This Workflow Does

This workflow stops automated emails and texts from going to Amish patients who don’t use electronic communication. It respects their communication preferences and avoids outreach that wouldn’t reach them, while staff continue to manage care and billing by hand.

The workflow begins when:

  • Staff adds the Amish (Non-member) tag to the patient’s chart in Cerbo.

What Happens Automatically

When the Amish (Non-member) tag is added

  • Do Not Disturb (DND) is turned on for the patient’s HighLevel contact, so no automated emails or texts are sent.
  • This applies across every workflow, including appointment reminders, nurtures, and billing messages.

What Staff Need to Do

Tagging the Chart

Staff adds the Amish (Non-member) tag in Cerbo as soon as it’s known that a patient shouldn’t receive electronic communication.

Communicating With the Patient

Staff handles all communication with Amish patients by hand, using approved non-digital methods.

How You’ll Know It’s Complete

  • The Amish (Non-member) tag is on the patient’s chart in Cerbo, and DND is on for all channels in HighLevel.

Expiring Credit Cards

What This Workflow Does

This workflow helps prevent missed payments by reminding patients to update a credit card that’s about to expire. Staff identify the expiring cards each month, and the reminders go out automatically from there.

The workflow begins when:

  • Staff adds the Expiring Credit Card tag to the patient’s chart in Cerbo.

What Happens Automatically

When the Expiring Credit Card tag is added

  • The patient receives a short series of emails and texts reminding them to update their payment method before the card expires.

When the Expiring Credit Card tag is removed

  • Any remaining reminders stop.
  • If the patient is still active, they receive a thank-you message.

If the patient doesn’t update their card

  • Their next payment attempt fails, and the Pay Fails workflow takes over, including any staff follow-up.

What Staff Need to Do

Finding Expiring Cards Each Month

On the first business day of the month, Staff runs the expiring credit card report in Cerbo.

  • Go to Reporting → Financial Reports → Patient Credit Card and Subscription Report.
  • Click the Card Expires column header to sort by expiration date.
  • Open each active patient’s chart with a card expiring next month, and add the Expiring Credit Card tag.

Once the Card Is Updated

Staff removes the Expiring Credit Card tag in Cerbo. That stops the reminders and sends the patient a thank-you.

If the Patient Does Not Wish to Continue

Follow the Pt Cancellation steps.

How You’ll Know It’s Complete

  • The patient’s payment method is updated, and there is no Expiring Credit Card tag on the chart.
  • Or, the card expired without an update, and the patient has moved to the Pay Fails workflow.

Pay Fails

What This Workflow Does

This workflow manages failed membership payments. When a payment fails, it sends the patient a series of reminders to update their payment method and pay their balance, and brings in staff only when a link, a letter, or a decision about inactivation is needed.

It covers two kinds of failed payments: a new member’s first prorated month, and an existing member’s recurring monthly payment.

Note: A failed payment on a brand-new signup, before the enrollment fee is paid, is handled by Abandoned Cart Nurture.

The workflow begins when either:

  • A new member’s prorated first-month payment fails.
  • An active member’s recurring membership payment fails in HighLevel.
  • Staff adds the Pay Fail tag in Cerbo for a membership that still bills in Hint.

What Happens Automatically

If a new member’s prorated payment fails

  • The patient’s opportunity in the Patient Journey pipeline is renamed to start with “PAY FAIL -”, so it stands out.
  • The patient receives a short series of emails and texts asking them to update their payment method.
  • Their onboarding waits until the payment goes through.

If an active member’s recurring payment fails

  • The Pay Fail - Recurring Membership tag is added in HighLevel, and the Pay Fail tag appears on the patient’s Cerbo chart.
  • Staff is notified to create a payment update link for the patient.
  • Once the link is added, the patient receives a series of emails and texts asking them to update their card and pay their balance.
  • Payment update links expire after 30 days, so staff is notified three more times during the series to replace the link with a new one.
  • If the balance is still unpaid, staff is notified to send the 60-day letter, then the 90-day letter a month later.
  • At the end of the series, staff is notified to review the patient for inactivation.

When the payment succeeds

  • All reminders stop, and the pay fail tags and payment update link are cleared.
  • A new member’s opportunity returns to its normal name and onboarding continues. An active member receives a thank-you message.

What Staff Need to Do

Hint Memberships

If a membership that still bills in Hint has a failed payment, Staff adds the Pay Fail tag to the patient’s chart in Cerbo.

Note: Payments that fail in HighLevel start the workflow on their own.

Payment Update Links

Daniela receives a task to create a payment update link. In HighLevel, go to Payments → Subscriptions, open the patient’s subscription’s three-dot menu, and add the link to the patient’s Payment Update Link field. The reminders wait until the link is added.

Payment update links expire after 30 days. During the reminder series, Daniela receives three more Create New Payment Update Link tasks. Each time, create a new link the same way and replace the old one in the Payment Update Link field. The reminders keep going on schedule without waiting for these, so add the new link the day the task comes in. Otherwise, the next reminder goes out with the old link.

60-day and 90-day Letters

Daniela receives a task in Cerbo to mail the 60-day letter, and a month later the 90-day letter, if the balance is still unpaid.

Review for Inactivation

Marisa receives a task at the end of the series to decide whether the patient should be inactivated for bad debt under practice policy. If so, submit the Patient Inactivation form with Bad Debt selected.

If the Patient Does Not Wish to Continue

Follow the Pt Cancellation steps.

How You’ll Know It’s Complete

  • The payment went through, and there is no Pay Fail tag on the chart.
  • Or, the patient has been inactivated for bad debt.

Patient Cancellation

What This Workflow Does

This workflow handles patient-initiated cancellation requests, whether a patient is canceling an entire membership or removing one or more household members. It makes sure the request is documented in writing, the patient receives the cancellation policy details that apply to them, and staff are notified at the right times.

The workflow begins when:

  • Staff adds the Cancellation Info Given or Remove Member Info Given tag to the patient’s chart in Cerbo after the patient asks to cancel.

What Happens Automatically

When staff adds the tag

  • Cancellation Info Given, for canceling the entire membership: the patient is emailed the cancellation policy details and the form to submit their request in writing.
  • Remove Member Info Given, for removing one or more household members: the patient is emailed the details for removing members and the form to submit their request in writing.
  • If the patient doesn’t submit the form within a month, the tag is removed automatically.

When the patient submits the form

  • Staff is notified to set the inactivation date and end the subscription. If the whole family is canceling, the task also asks for a Patient Inactivation form for every other family member.
  • The Pt Inactivation & Reversal workflow begins.

Once the inactivation date is added

  • The Canceling tag is added to the patient’s Cerbo chart, with the inactivation date in the tag note.
  • The patient receives a cancellation confirmation email.

What Staff Need to Do

When a Patient Asks to Cancel or Remove a Household Member

Staff lets the patient know they’ll receive a quick email with the cancellation policy details and a form to submit their request, so it’s documented in writing. Then add the right tag to the patient’s Cerbo chart: Cancellation Info Given for the entire membership, or Remove Member Info Given for removing members. The tag sends the email.

Note: Don’t send the form link directly. Sending the link on its own skips steps the system needs to process the request.

Canceling Tasks

Melissa receives a Canceling task in HighLevel when the patient submits the form. Add the inactivation date to the patient’s record and set the subscription to end the day before the next billing date. If the whole family is canceling, also submit the Patient Inactivation form for every other family member. The task shows the Family Group ID. If only one household member is leaving, the task asks her to adjust the payor’s subscription instead, as described in Pt Inactivation & Reversal.

Note: The rest of the cancellation is handled by the Pt Inactivation & Reversal workflow.

How You’ll Know It’s Complete

  • The patient has submitted the cancellation request form.
  • The patient’s chart has the Canceling tag, with the inactivation date in the tag note.

Patient Inactivation & Reversal

What This Workflow Does

This workflow manages the inactivation of patients due to cancellation, dismissal, or bad debt. It makes sure every inactivation is handled the same way, completed fully with no steps missed and no further messages to the patient, and properly timed, from confirmation through billing, tagging, staff tasks, and final chart cleanup.

If a cancellation is reversed before the inactivation date, the workflow stops and restores the patient to an active state.

The workflow begins when either:

Note: The Inactivation Date is the date the patient becomes inactive in both systems. It’s usually the 1st of the month after the patient’s last paid month, and the membership subscription ends the day before. Past dates are fine. If the date has already passed, the workflow moves straight to the inactivation steps.

What Happens Automatically

When a cancellation is submitted

  • Staff is notified to add the Inactivation Date, end or adjust the subscription, and clear the family’s associations in HighLevel.
  • Once the Inactivation Date is added, the Canceling tag is added in Cerbo with the date in the tag note, and the patient receives a cancellation confirmation email.

When Bad Debt is selected

  • The Bad Debt tag is added in both systems.
  • For a family, staff is notified to clear the family’s associations.

When Dismissal is selected

  • The Dismissed tag is added in both systems, with the Inactivation Date in the tag note in Cerbo.
  • For a family, staff is notified to clear the associations, for the dismissed patient only or for the whole family.

On the Inactivation Date

  • The Inactive Patient tag is added in HighLevel, and the patient’s active membership, location, and workflow tags are removed.
  • Staff receives a task in Cerbo to inactivate the patient and remove the renewal date and program tags.
  • The patient is removed from all active workflows.

If a cancellation is reversed

  • The patient is removed from this workflow right away, the Canceling tag is removed, and the Inactivation Date is cleared.
  • Staff is notified to remove the end date from the patient’s subscription.
  • The patient is restored to an active state, with their Active Patient and location tags, and stays in their normal workflows.

What Staff Need to Do

Starting an Inactivation

For inactivations staff starts, whether bad debt, dismissal, or a cancellation staff is handling for the patient, Staff submits the Patient Inactivation form, one form per person, and includes the reason. If the patient submitted the cancellation request form themselves, no Patient Inactivation form is needed for them.

Cancellations

Melissa receives a Canceling task in HighLevel. Add the Inactivation Date to the patient’s record, then:

  • For an individual or an entire family, set the subscription to end the day before the next billing date. For an entire family, also submit the Patient Inactivation form for every other family member and clear the family’s associations from the payor’s contact. The task shows the Family Group ID.
  • For one person leaving a family, end the payor’s current subscription the day before the next billing date and start a new one, update the count field under the payor to remove this patient, and clear the association for this family member only.

Bad Debt and Dismissals

Marisa ends the membership billing the day before the Inactivation Date. For a family, Melissa receives a task to clear the associations from the payor’s contact: the entire family for bad debt, and either the dismissed patient only or the entire family for a dismissal.

On the Inactivation Date

All Membership Coordinator receives a task in Cerbo to inactivate the patient and remove the renewal date and program tags. Depending on the reason, this may also include confirming there are no future appointments and adding any internal notes.

If Circumstances Change Before the Inactivation Date

Staff submits the Patient Inactivation form again with Cancellation Reversal selected. Melissa then receives a No Longer Canceling task to remove the end date from the subscription, and to close any Canceling task for the patient that’s still open without completing it.

How You’ll Know It’s Complete

  • The Inactivation Date has passed, the patient is inactive in Cerbo, and their active patient and membership tags are removed.
  • Or, for a reversal, the inactivation tags are removed, the patient is still active, and there is no billing end date on their membership in HighLevel.

Form Links to Bookmark

These are the forms staff submit. Bookmark them so they’re easy to find.

Note: These forms are for staff only. Never send them to patients.

Helpful Resources

Training Recording

Your Automation Success Training Session from March 18, 2026 walks through the system with your team. It’s a helpful reference for onboarding new staff or refreshing on how the workflows fit together.

Additional Support

This guide was created to support your team with clear, consistent workflows and reliable automations that reduce manual work and enhance patient experience. If your team needs help updating or optimizing any part of this system, our team is always here to assist.

Automation Ally: support is available:

Prepared by Automation Ally 1-27-26 · Updated 11-9-26 Automation Ally