When a Professional Contact is used for incoming referrals, they must be assigned an appropriate Professional Category, and it's all to do with the way referral information is submitted online.
Contained within an online claim for an invoice is information about the referral applicable to the services being claimed. Although the referral shows an end date in CareRight, this is not actually used to determine if the referral was suitable, instead the following details are used:-
- Referral Issue Date
- Referral Date From (Referral Activate Date)
- Referral Period Type
- Referring Provider Number
The critical piece of information here is the Referral Period Type, which can have 3 values
- Standard
- Indefinite
- Non Standard
Indefinite referrals are identified from the text 'Indefinite' in the Notes field of the referral
In order to determine if a referral duration is Standard or Non Standard, CareRight needs to know the Professional Category of the provider, and therefore if their standard referral is for 3-months (eg Medical Specialist) or for 12-months (eg General Practitioner). CareRight looks at the Referral Activated Date and the Referral Date To to get the duration and then compares that to the default for the relevant Professional Category to determine if the referral is Standard or Non Standard
