Problem Statement

Referrals must be received, validated, and acted on before a specialist visit, because many payers require an authorized referral on file or the visit denies. When a patient has no authorized referral for an upcoming General Surgery visit, the referral has to be authorized if one is pended, or requested from the PCP, with timed reminders as the date of service approaches. Working each one manually across the queue is labor-intensive, and a referral that isn't secured in time leaves the visit exposed to denial.

Automation Solution

This automation authorizes pended General Surgery referrals or sends PCP referral requests for patients without an authorized referral, escalating with reminders at 14 days, 5 days, and then daily prior to the date of service.