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, and that status sits on payer websites until it's looked up. Checking each pending referral manually is slow and repetitive, and a referral whose authorization goes unnoticed leaves the visit exposed to denial.

Automation Solution

This automation checks payer websites for the status of pending Epic referrals and updates the referral shell to Authorized when an approved referral is found.