Since we do a lot of primary care, referrals is a big part of what we do. Depending upon the insurance company will determine the steps needed. Depending upon the insurance plan will determine if we can send the referral or not. Regardless, we should get in contact with the Patient about next steps and guide them. Look below for the details on how to do this. 




📚Resources Needed




🚀 Tips & Tricks

  • Pull up the Patients benefits information to see what is needed. Depending upon what is needed will determine how the referral needs to be submitted.  
     
  • Call around to a few different providers to see who can see the Patient the soonest.



📘 Instructions

Make sure not to forget one of these steps. 

  1. You will see the referral order there in the orders page in the Draft field. 

     

     
  2. Click on the action icon and select Edit.  

     
  3. Open up a new tab and search the Patient name at the top to pull up their Patient detail page > Click Demographics so you can get their insurance info. 

     
  4. Login to United Healthcare. 

     
  5.  From the homepage, click on Eligibility



     
  6. Make sure that the Payer and Provider are correct in the top right corner. 



     
  7. In Eligibility and Benefits, scroll down until you see what steps may be needed for the referral. 


     
  8. You can also click on the Referrals tab, search by entering in the members information and it will tell you what actions may be needed. 



     
  9. To get the referral provider, go to the provider directory.  

     
  10. Make sure to select the correct plan that the Patient has. If you don’t, you may be sending them information to a doctor that cannot see them. 

    🚨This can be found on their insurance card, or insurance details when searching the Patients eligibility. 

     
  11. Make sure you put the correct zip code to where the Patient lives and search for the type of provider that is listed there on the order form. 



     
  12. You will now see all the providers listed. Look for providers with their name showing. This is a better chance of getting a non health system and therefore the Patient will have a much better experience. 



     
  13. Google something like Cardiologist in Huntington Beach. We would like to google it as well because it gives you an idea for the type of provider they are. Ideally, we do not want to send the Patient to a big medical network because we cannot create relationships with them. The small specialists we can and eventually bring them on board to work with us as a team. Here is a good example: 



     
  14. Now, find the doctors name that is in that specialty and search them in the United provider search. 



     
  15. Click on the listing to pull up the provider details. We will want to call them and tell the the following information: 
    1. We have a new Patient that needs to see the provider. 
    2. Ask them when the next availability is for a new Patient
    3. Get their email address. We send them an email with Patient info. They just need provider NPI to access the document. 


⚠️Call around to see what provider can be the soonest. 

 

  1. Once you have the provider, go back to the respective order and add the provider in the guest provider fields. Most of all information will be found on the United provider search site other than their email address. 

     
  2. When you select Guest Referral within the order form, these fields will populate. Fill them in with the Provider info and click Save. 



     
  3. Give a few seconds for the guest provider info to populate. 

     
  4. Review all the information of the order. 

     
  5. Once you have reviewed, make sure the order status is PENDING and click Save. 

     
  6. Using the information, send a chat to the Patient using the following Template: 

    Hi {Patient name} we have sent a referral out for you. We had called around to get the provider with the soonest availability. You will need to reach out to the office and schedule an appointment. When speaking to them, make sure to provide them with your insurance card info. Here is the information for the referral {Name, Address, Phone}. If we can assist with anything further please let us know. 😊



     

Here is a video to help you out. 

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