Referrals & Authorizations

Referral Management and pre-authorization of services are cumbersome tasks facing physician practices involved in the delivery of managed care. The process of movement of patients between primary care providers, specialists and institutions is now tightly managed, and requires a great amount of detailed information to be exchanged with insurance plans and case managers that monitor the delivery of care. In addition, some plans require that authorization be given for certain types of services before they are delivered to the patients. This is to ensure that the plan can determine the necessity of the proposed services, and maintain control over the expenses that are made on the patient’s behalf.

MedcomSoft Record enables the practice to capture, track and manage all relevant information pertaining to the referral and authorization process from one central area.

Features & Functionalities

• Referrals Management
• Manage and track inbound and outbound referrals
• Maintains list of approved providers/sites by insurance plan and provider preference
• Track and warn for multiple allowed visits, dollar amounts, or date periods of eligible service
• Enter entirely codified data for directions through MEDCIN, CPT, ICD or enter subjective description
• Warn if out-of-network providers are not authorized for a given plan
• Output detailed referral or authorization forms to be filled out, or printed with detailed information for correspondence
• Append attachments, tasks, audio notes, and reports to referrals, and track which reports have been reviewed vs. those outstanding
• Track and log responses for approved, denied or revised referrals and authorizations