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. For scheduled specialist visits with certain payers, the referral has to be created directly in the payer portal and then reflected back in the EMR so the record stays accurate. Creating each referral by hand in Availity and updating the EMR is slow and repetitive, and a referral that isn't submitted in time puts the visit at risk of denial.

Automation Solution

This automation creates new referrals in Availity for scheduled specialist visits, monitors their status, and updates the EMR so the record stays accurate.