8 Important Tips on How to Prevent Delays in the Referral Process
Did you know?
CAPHS is asking your patients this question: How satisfied were you with your ability to get an authorization for a specialist, test, or procedure when you needed it?
How will your patients answer?
Well, one way to make sure their experience is a positive one is to learn and master the ways to prevent delays when referring patients. Whether the referral is for a test, procedure, or to see one of our specialists, you can help move things along much quicker by having the right information.
Here’s how:
1. Document everything!
We can’t say this enough. It’s always important to include medical history to help support what medical procedures are being done. Requests will be delayed without it. You can supply documentation in 3 ways:
- Upload records to the web portal. It’s the most efficient way!
- Copy & paste them from Next Gen to the notes section of the authorization
- Type the information in the notes
- Do not fax the information. It just causes delays.
2. Check eligibility
3. Make sure you are selecting a specialist from the drop-down menu
4. Include the referring physician and provider/facility who will be providing the service
5. Include procedure (CPT) and diagnosis codes
6. Select the correct urgency!
Unless there is an actual medical emergency, it should be submitted as “Routine”. Submitting non-medically urgent referrals as “Urgent” will only delay the process for the ones that are true emergencies.
7. Select providers that appear for the member in their referral network.
Do not select “Provider not listed” unless there are no providers that appear for the member within their network who can provide the requested service. To avoid delays and call from the department requesting further information, give a thorough explanation about why this provider is needed.
8. Regularly follow up within 48-72 hours to timely approval.
Date and time stamp all prior authorization submission materials and store in a tickler file or enter a reminder in the electronic health record.
We hope these tips will help you master your referral skills. It helps to keep us organized while improving our patient satisfaction, which in turn, helps to improve your satisfaction scores.