Referral management

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Referral order created

   Primary care provider submits a specialist referral through the EHR system. The referral includes patient demographics, clinical notes, and specialty requirements.

   EpicCerner
2. 2

   Action

   Verify insurance authorization

   System automatically checks patient's insurance coverage and determines if prior authorization is required for the specialist referral. Submits authorization request if needed.

   AthenahealthEpic
3. 3

   Decision

   Route based on urgency

   Evaluates referral urgency level and clinical priority to determine appropriate specialist and timeframe. Routes urgent cases to expedited scheduling queue.

   EpicCerner
4. 4

   Action

   Match to specialist network

   Identifies available specialists within patient's insurance network and geographic preferences. Filters by specialty, availability, and referral requirements.

   AthenahealthDrChrono
5. 5

   Action

   Schedule specialist appointment

   Automatically books the earliest available appointment slot with the matched specialist. Sends appointment details to both patient and referring provider.

   EpicKareo
6. 6

   Action

   Send patient notifications

   Delivers appointment confirmation, preparation instructions, and specialist contact information to patient via preferred communication method. Sets automated appointment reminders.

   AthenahealthDrChrono
7. 7

   Output

   Generate referral tracking report

   Creates comprehensive referral status report for referring provider with appointment details, authorization status, and patient communication log.

   EpicPractice Fusion

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