Referral & Network Checks
Check the referral and network details that affect an upcoming visit. Keep the ordering provider, servicing location, planned service and plan requirements together instead of treating every coverage question as the same check.
How the work moves.
A referral, an authorization and network participation answer different questions.
- 01
Match the ordering and servicing providers, location and planned service.
Match the check to the intended provider, service and location.
- 02
Check referral requirements, validity dates and available network information.
Review available referral requirements, validity dates and network information.
- 03
Flag missing referrals or unresolved network status for staff follow-up.
Route missing referrals and unresolved plan-specific questions before the visit.
A request,
with its context intact.
A patient is scheduled with a specialist. A referral is on file, but its validity dates do not cover the planned visit.
Fictional example · No patient data or external action
- On file
- Specialist referral
- Gap
- Visit falls outside the recorded referral dates
- Follow-up
- Staff confirms whether an updated referral is needed
Start with the
right information.
Keep these details with the request so the next person can review the work without repeating the intake.
- Patient, plan and planned service
- Ordering and servicing provider information
- Service location and expected visit date
- Referral documents and available network responses
About this workflow.
Are a referral and an authorization the same thing?
No. They address different requirements. Keep their records and unresolved questions separate even when they relate to the same visit.
Does a provider directory guarantee payment?
No. A listing is one source of information. Plan-specific participation, service details and payment rules still need appropriate confirmation.
Related workflows.
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