Incoming, Internal and Outgoing Referrals

The following resources provide information on Incoming and Internal Referrals and Outgoing Referrals functionality.

Resources

Incoming and Internal Referrals

General

Changing the Scheduling Status of an Incoming or Internal Referral - (Handout) The Scheduling Status for incoming and internal referrals is manually changed to reflect the correct scenario. A comprehensive list of Scheduling Statuses is provided in this document.
Creating Referrals from Incoming Web Requests- (Handout) When an external provider submits a referral web request, or a patient submits an appointment web request, it falls to the UIHC Appointment/Referral Web Requests Appointment Request Workqueue.
Identifying a Care Everywhere Referral - (Handout) Care Everywhere referral information will display in various activities in Epic and the Care Everywhere activity can also be opened from these activities.
Incoming Care Everywhere Referrals - (Handout) Incoming Referrals from Community Connect Providers
Incoming Referrals from Community Connect Providers - (Handout) When a provider at a Community Connect location refers a patient to UIHC, the referral record is available in the relevant UIHC Referrals workqueues and RFL Triage Messages. From the referral, the patient's Appt Desk, Chart, Patient Station, and Registration can be opened. If the patient needs to be looked up in non-Referral workflows, users must Break the Glass to access the record until a UIHC encounter is documented.
Managing Referral Triage Messages for Providers - (Handout) Referral Triage Messages are used to communicate referral information. At times, insurance prior authorization related requests may be sent to providers.
Re-opening a Closed Incoming Referral - (Handout) If an incoming referral is closed and needs to be re-opened, the referral can be re-opened from the Appointment Desk.
Sending a Manual Notification Letter to a Patient’s MyChart Account - (Handout) If a patient has an active MyChart account and the patient cannot be reached, a notification letter can be manually sent from the Referral record to the patient’s MyChart account. The notification letter indicates we have tried contacting the patient, and asks the patient to contact us. The letter is sent after attempts to reach the patient through other means have failed.
Using a Questionnaire for Referrals Document Collection - (Handout) Incoming and internal referral records provide an optional questionnaire to assist with tracking document collection needed for scheduling of the referral.

Referral Entry & Workqueues:

DOC

Working the Incoming Referrals for DOC Needs Update Workqueue - (Handout) Incoming Department of Corrections (DOC) referrals, entered into Epic manually or via UI CareLink, will fall to the “Incoming Referrals for DOC Needs Update” workqueue in the following scenarios: The Patient Type field is blank. OR The patient does not have State Institution coverage listed. Staff will update registration appropriately. Once completed, the referral will fall off of the “Incoming Referrals for DOC Needs Update” workqueue to the “Incoming Referrals Ready to Sched” workqueue for scheduling.

Financial Counseling

Working the Incoming Referrals to Financial Counseling Workqueue - (Handout) Incoming referrals which PFS determines need Financial Counseling review will fall to the “Incoming Referrals to Financial Counseling” workqueue. Once Financial Counseling is confirmed, the referral record is updated to indicate it is “Ready to Schedule”. The referral can also be sent to HCBAP or denied from this workqueue.

HCBAP

Working the Incoming Referrals to HCBAP Workqueue - (Handout) Incoming referrals which need HCBAP review will fall to the “Incoming Referrals to HCBAP” workqueue. Once HCBAP workflows are complete, access the referral record in Epic and mark it as “Ready to Schedule, “ or send the referral to Financial Counseling if needed.

Insurance Authorization

Working the Incoming Referrals Need Insurance Auth Workqueue - (Handout) If authorization is needed for an incoming referral, the referral will fall to the “Incoming Referrals Need Insurance Auth” workqueue for a referral specialist to work.

Other

Workers Compensation Referrals - (Handout) Referrals related to a Workers Compensation claim will be flagged as Workers Comp referrals. This enables the Workers Comp team to validate the information before scheduling from their Workers Comp Referrals workqueue. After validation and WC needs are completed, the Work Comp team will add a note indicating their work is done. This enables scheduling for the referral. The Work Comp team will still see the referral for monitoring in their UI Workers Comp Referrals workqueue.
Working the Incoming Referrals Incomplete Information Workqueue - (Handout) Incoming referrals fall to the “Incoming Referrals Incomplete Information” workqueue if the referral record is missing certain information. Once the referral record is updated with the missing information, the referral falls off of the workqueue and is routed through the normal incoming referrals workflow.
Working the Wellmark OON Incoming Referrals Workqueue - (Handout) When a referral is received from a Wellmark sender, a manual incoming referral is created following the normal workflow for creating a manual incoming referral, using Priority “F. Wellmark 30 days”. If the referral needs to be pended, the "Wellmark Pend Review" flag is added, and removed when appropriate.

Referral Entry

Creating a Manual Referral Record from Incoming Referral Requests - (Handout) Referral requests received from external parties are entered into Epic by manual creation of a referral record.

Registration

Working the Incoming Referrals Need Coverage Verification Workqueue - (Handout) Incoming referrals fall to the “Incoming Referrals Need Coverage Verification” workqueue for Registration to work if the patient’s coverage status includes either the patient having no coverage, or the patient’s coverage being unverified (includes both RTE and non-RTE plans). Registration will update coverage to a verified status so scheduling can occur, or mark the patient as a self-pay patient and Epic will route the referral to Financial Counseling.

Scheduling and Triage

Accessing and Reviewing an Incoming or Internal Referral for Scheduling - (Handout) Incoming and internal referrals are first reviewed in the Referral workqueue before they can be scheduled.
IRL Radiology Same Day Referrals - (Handout) When a provider writes a radiology order for a patient, a referral is generated if the testing requires pre-authorization. At Iowa River Landing, if there is a same day opening and the patient wants to have the test performed today, front desk staff must add a Same Day patient preference flag to the referral record. This flag triggers a page and sends the referral to a workqueue for Pre-Auth staff to work immediately.
Requesting Triage for an Incoming or Internal Referral from a Clinician - (Handout) A referral can be sent to a clinician for triage using RFL Triage MSG in the referral workqueue. If the clinician responds requesting additional information, further communication beyond the initial request can be sent using the Triage form of the Referral record.
Reviewing and Updating the Priority of an Incoming or Internal Referral - (Handout) Incoming and internal referrals are assigned a Priority indicating the timeframe in which the referred by provider wants the patient to be seen. The Priority can be updated in the referral record as needed.
Scheduling a High Risk HMO Patient - (Handout) Some HMO plans are unlikely to pay for services if authorization is not obtained prior to the patient's appointment. To prevent this, patients with these plans should be scheduled from a "Ready to Schedule" referral.
Triaging an Incoming Referral for Scheduling - (Handout) The clinician will receive an In Basket message requiring scheduling triage in the “Referral Triage” folder, and “Accept” or “Reject” from within the In Basket message. The clinician can also request additional information from the scheduler, request the scheduler redirect the referral to a different department specialty, or forward to additional clinical staff for triage review.
Working the Incoming Referrals Ready to Schedule Workqueue - (Handout) Incoming referrals are entered into Epic. When these referrals are ready to schedule, they will fall to the departmental workqueue for scheduling, displaying a Sched Status of “Ready to Schedule”. Prior to scheduling, if the referral needs to be triaged by a clinician, the scheduler can send a triage scheduling request (RFL Triage Msg) in Epic.

VA Consults

VA Consult Referrals - (Handout) After a VA Consult is received and scanned into OnBase, the document will automatically create a referral record and route to a workqueue for review and updating. After the referral record is updated, the record will follow normal referral processes.

Outgoing Referrals

Managing Referral Notification In Basket Messages for *UICOM Outgoing Referrals - (Handout) When a physician places an external order for a procedure to occur at an outside organization, a referral is auto-created in the Epic system based on the ordering department.
Managing Referral Notification Messages for Outgoing Procedures - (Handout) At times, a UIHC provider may write an order for a procedure for a UIHC patient in which the patient opts to have the procedure performed at an external organization. After the UIHC provider writes the order, a referral record is automatically generated from that order (currently for only some orders). Based on the patient’s coverage, authorization may or may not be required prior to scheduling. Once scheduling is appropriate, a Referral Notification In Basket Message is automatically sent to the appropriate In Basket pool to communicate scheduling can occur.
Outgoing (External) Referrals - (Handout) Referrals to external providers or locations from UICOM clinics fall to a specific workqueue where communications with insurance, the external provider, and the patient can all be documented, as well as the external appointment date and any follow up needed on the referral.

In Basket Pools

In Basket Pools are used to send a shared message to a group of recipients. The recipients all receive a single message that requires action from any one person in the group. When one person in the pool completes the task and marks the message as Done, the message disappears from all other pool members' In Baskets.

Managing In Basket Pools - (Handout) Users that have security to manage In Basket pools may add, remove or sign other users into a pool using the Manage Pools activity.
Send to an In Basket Pools - (Handout) A pool can be entered in the recipient field when sending a message or routing an encounter.
Working with In Basket Pools - (Handout) Signing in or out of a pool, indicate responsibility for a pool message, and transferring responsibility for a message.

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