Referrals - Overview

Referrals are letters between medical professionals, handing over the care between parties. When dealing with Referrals for Specialist Treatment, referral letters must meet certain criteria to be usable in medicare claiming. 

CareRight supports both receiving referrals - by physical letter, scanned into the system, by secure messaging, or by Online Enquiries and Expressions of Interest; and modelling your outgoing referrals.

This article focuses on management of referrals at an individual patient level. See High Volume Referral Triage and Management for practice wide recommendations.

Viewing a Patient's Referrals

Up to 3 active referrals are indicated in the patient banner.

CareRight allows you to record a referral against a patient record. From the selected patient record select the Referrals menu item. This will display the Referrals screen. This screen will display any Medical Referrals or list Professional Contacts.

CareRight allows you to record a referral against a patient record.  From this screen you can:

• Add a Medical Referral (by clicking Referral In) - required for certain types of billing
• Create an outbound Referral (by clicking Referral Out)
• Add a Local Medical Officer (LMO)  Relationship (By clicking New LMO)
• Add a correspondence only relationship  (by clicking New Contact)

The screen is split into the following sections:

• Medical Referrals
• Professional Contacts

Current Tab selected:

• Displays Medical Referrals: These referrals are not disabled, are currently active, and/or have a future activation date; and,
• Displays Medical Referrals that have expired within the last 6 months: These referrals are not disabled, are not active (i.e., past activation date), and have an expiry date less than 6 months old from the current date.

History Tab selected:

• Displays Expired Medical Referrals: These are referrals that have expired, but are not yet disabled;
• Displays Disabled Medical Referrals: These are referrals that have been disabled; and,
• Displays Disabled Professional Contacts: These are professional contacts that have been disabled.

Adding a Specialist/Medical Referral from a GP

To add a Medical Referral, follow these steps:

1. Search for a patient in need of a referral.
2. Click Show.
3. In the Main Menu, click Referrals.
   1. Any existing referrals will be visible on the screen, check that the referral hasn't already been added, if it hasn't proceed to the next step
4. Click Referral In.
5. Select who the Referral is from (Practitioner) from the list (if the practitioner is not in the list then jump to the next section Why would a practitioner not be listed?)
   1. Practitioners will only appear in the list if they have a valid provider number
   2. Note: If you cannot see the practitioner in the list, try searching via their provider number.
6. Complete fields using the table below for reference.
7. Click Create Referral.

Medical Referrals 

When you select " Referral In" to add a Medical Referral, the information will display in this summary.  To view Referral information, select the Show button next to the relevant Referral.

Adding a Referral from another party

You can also record a relationship that a patient has with a professional contact that, or for an informal referral (non-medical).  This could be the relationship between the patient and their GP, where their GP referred them to the specialist that you have received a medical referral from.

You can record two types of relationship here:

• A LMO relationship (click New LMO).
• Correspondence Only relationship (click New Contact).

To record a relationship, follow these steps:

1. Search for the patient that the referral is for (Patients → Search → Show).
2. From the patient's record, select Referrals from menu.
3. Any existing referrals will be visible on the screen, check that the referral hasn't already been added, if it hasn't proceed to the next step.
4. Click New LMO or New Contact.
5. Select a Practitioner from the list.
6. Complete the fields using the table below for reference.
7. Click Create Referral.

Viewing an existing Referral

1. Click Show on a referral row listing.
   1. The details of the referral will appear.
2. Note: If the referral is non-standard, expired, or disabled, then a warning message will appear above the referral.

Referral Durations

There are three types of referral durations:

• Standard
• Non-standard
• Indefinite

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

An indefinite referral has no specific expiry date.

Indefinite tag displays when selecting a referral for an invoice:

Modelling external Professional Contacts who should receive communications or participate in a patient's care

When you click "New LMO" or "New Contact" and add a relationship, the information will appear here. To view referral information, click the Show button.

Important Notes:

1. Professional Contacts are set up in CareRight via CareRight Dashboard → Professional Contacts → New. 

• When setting up a Professional Contact it is important to remember that the Professional Category field i.e. GP, Neurologist will drive the period of the Referral i.e. 3 months / 12 months. 
• Also, that the Professional Contact must have a Provider Number. If these values are not correctly set up then a Referral will not be classed as a Medical Referral. 

  2. If you are adding a referral to a patient's record and the referring practitioner is not present in the drop-down list, this could be for one of two reasons:

• They are not registered as a Professional Contact; and/or,
• They are listed as a professional contact and don't have a provider number. ^*

 ^* It is important to ensure all professional contact records that represent a practitioner providing a medical referral have a valid provider number. 

Note: If you cannot find the provider by searching using their name, try searching utilising their provider number - this will ensure that you don't create duplicate contacts. You can add a provider number to an existing professional contact by following the steps in Add a Provider Number to a Professional Contact.

Marking a Referral inactive

Expiring Referrals

Each night a process runs that marks any referrals that have expired as inactive.  No manual intervention is required to expire referrals. When raising an invoice for a Patient, any expired Referrals will display with the text in Red and highlighted for easier identification

i.e Dr Harry Smith Provider No. 12345675w Expired on: 24/09/2017

Expiring Referrals Manually

1. Search for a patient.
2. Click Show.
3. In the Main Menu, click Referrals.
   1. Any existing referrals will be visible on the screen.
   2. Note: To disable an expired referral - access the referral under the History tab.
4. Select the Show button, next the Referral you wish to make inactive.
   1. The referral details will display.
5. Click Edit.
6. Select the Disabled (check box - True/yes/checked).
7. Click Update Referral.
   1. A green successful message will display – Referral was successfully updated.
8. The Referral Status is Inactive, and the Recipient status is No Copy.

Referring a patient to another service or provider (Referral Out)

Practitioners are able to raise a referral for external practitioners to your organisation (i.e., a Referral Out):

1. Search for a patient.
2. Click Show.
3. In the Main Menu, click Referrals.
   1. Any existing referrals will be visible on the screen, check that the referral hasn't already been added, if it hasn't proceed to the next step.
4. Click Referral Out.
5. Select Referral To.  
   Note:  CareRight requires a provider number recorded against a medical provider to ensure correct referral out for this contact. For an informal referral (non-medical) or LMO referral - see Add a referral for LMO / informal referral (non-medical).
6. Complete fields using the table below for reference.
7. Click Create Referral.