Real-Time Referral Request

The managed care referral procedure is one of the most frustrating administrative processes that burdens healthcare providers. Unfortunately, many providers are spending more than they should on managing the referral process because their employees are equipped with ineffective and impractical tools.

The complexities of multiple managed care rules and the numerous steps required to successfully complete the process have caused many practices to dedicate a full time referral clerk to serve as the single point of responsibility for coordinating the referral process. Front office administrative employees are forced to rely on a combination of paper forms, patient charts, telephone calls, a fax machine, and US mail to complete insurance payer-mandated referral procedures. The resulting manual processes are expensive, annoying, and associated with many hidden costs: disruptions to patient care, frequent interruptions in workflow, otherwise unnecessary chart pulls, confusion regarding plan-approved providers, incomplete forms, and unreliable or "stale" data. Real-time Referral features from HealthFusion^® make this process easy.

Key Benefits:

• Efficiently create referrals online
• Electronically track referral authorizations
• Reduce risk of denial
• Search ICD (International Classification of Diseases) and CPT (Current Procedure Terminology) databases online
• Distribute referral information electronically without the need to fax
• Reduce the number of daily "chart pulls".

Real-Time Referral Status Inquiry

Once a referral has been submitted, HealthFusion users can check its status online. Patient questions regarding the authorization of a referral can be answered efficiently, and specialists can electronically approve the document, thereby reducing the risk of future claims denial.

Now with HealthFusion, a referral is entered online with just a few clicks and keystrokes – and as soon as the payer authorizes the referral (in only two or three minutes in most cases), a confirmation goes to the practice and the specialist over the Internet. The primary care office receives its authorization number, and the consultant receives all the information needed to bill for the consult.