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. Inbound referral inquiries land in Epic workqueues for multiple payers, and each has to be checked against the referral on file: when a valid referral exists, the shell is updated and the account completed; when none is found, the case has to be set aside as an exception. Working these queues manually across payers is slow and repetitive, and an unworked referral leaves the visit exposed to denial.

Automation Solution

This automation works the Epic inbound referral workqueues for multiple payers, validates the referral found, updates the referral shell and completes the account, and generates an exception when no valid referral or shell exists.