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. Once a referral is pending with a payer, the visit can't be confirmed as covered until someone checks whether it's been authorized. For BCBS referrals that status lives in Availity, and checking each one by hand is slow, repetitive lookup work.

Automation Solution

This automation checks the status of BCBS referrals in Availity and updates the EMR with the current disposition.