Referrals in RXNT
Coordinate specialty care accurately from referral creation through patient follow-up.
This workflow explains how referrals should be created, documented, tracked, updated, and completed within RXNT. Proper referral management helps ensure patients receive timely specialty care, required authorizations are obtained, and communication between providers is documented throughout the referral process.
← Return to RXNT CenterWorkflow Purpose
Referral management extends beyond creating an order. Every referral should be monitored until the receiving provider has accepted the referral, the patient has completed the visit when appropriate, and any consultation notes or recommendations have been incorporated into the patient's ongoing care.
- Verify the patient and referral order.
- Confirm the specialty and receiving provider.
- Determine whether insurance authorization is required.
- Attach supporting documentation.
- Transmit the referral.
- Track referral status.
- Document patient communication.
- Review specialist reports and close the referral when complete.
Critical Standards
Confirm demographics, insurance, ordering provider, and referral destination before sending.
Include the diagnosis, clinical reason, supporting records, imaging, labs, and other documents needed by the specialist.
A referral is not complete simply because it was transmitted. Continue tracking until the referral has reached an appropriate outcome.
Record transmissions, patient communication, authorizations, scheduling activity, returned reports, and final resolution.
Referral Workflow Overview
Create Referral
Select the specialty, provider, diagnosis, and clinical reason.
Verify Requirements
Determine authorization, insurance requirements, and supporting records.
Send Referral
Transmit the referral with all required documentation.
Track Progress
Monitor scheduling, authorizations, returned records, and patient status.
Complete Referral
Review consultation notes, update the chart, and resolve the referral.
Common Referral Types
Specialist Referrals
Cardiology, Gastroenterology, Neurology, Endocrinology, Pulmonology, Dermatology, Rheumatology, and other medical specialties.
Mental Health Services
Behavioral health counseling, psychiatry, psychology, substance use treatment, and community mental health resources.
Testing & Procedures
Sleep studies, colonoscopy, endoscopy, cardiac testing, infusion services, and specialty procedures.
Rehabilitation
Physical therapy, occupational therapy, speech therapy, and rehabilitation services.
OB/GYN
Routine gynecology, prenatal care, fertility evaluation, and women's specialty services.
Support Services
Nutrition, social work, home health, durable medical equipment, and community assistance programs.
Referral Ownership
Once a referral has been placed, responsibility does not end until appropriate follow-up has occurred. Every referral should have a clearly identified owner responsible for monitoring progress and documenting updates until the referral reaches its final outcome.
Insurance Authorization Reminder
Some insurance plans require prior authorization before specialty care can occur. Verify payer requirements before scheduling whenever applicable. Authorization requirements may vary by payer, specialty, procedure, and network participation.
Step-by-Step Referral Workflow
Open the Correct Patient and Encounter
Verify the referral is being created in the correct chart and is connected to the correct clinical visit.
- Confirm patient name and date of birth.
- Confirm the ordering provider.
- Confirm the date of service and clinic location.
- Review the diagnosis and reason for referral.
- Verify current demographics and insurance.
Create the Referral Order
- Select the correct specialty or service.
- Enter the clinical reason for referral.
- Associate the appropriate diagnosis.
- Indicate urgency when directed by the provider.
- Add requested testing, consultation questions, or special instructions.
- Confirm the ordering provider is correct.
Identify the Referral Destination
Select an appropriate receiving provider or facility based on the order and available information.
- Confirm the specialty matches the referral.
- Verify the office is accepting new patients.
- Confirm the location is reasonable for the patient.
- Review payer participation when available.
- Confirm fax number, phone number, and contact details.
Verify Insurance and Authorization Requirements
- Confirm the patient’s active insurance plan.
- Determine whether a referral or prior authorization is required.
- Verify network participation when possible.
- Identify required forms or payer portals.
- Document authorization numbers, effective dates, and visit limits.
- Escalate out-of-network or coverage concerns before sending.
Attach Supporting Documentation
Include enough clinical information for the receiving office to evaluate and schedule the patient appropriately.
- Referral order
- Relevant office notes
- Patient demographics and insurance
- Laboratory results
- Imaging reports
- Medication list
- Procedure notes or prior specialist records
- Authorization documentation when required
Transmit the Referral
- Send through the approved electronic, fax, portal, or other secure method.
- Confirm the destination information before transmission.
- Review the transmission status.
- Document the date, time, method, and destination.
- Do not assume the referral was received solely because it was sent.
Notify the Patient
- Explain the specialty or service ordered.
- Provide the receiving office’s contact information.
- Explain whether the patient or referral team will schedule.
- Review authorization or network limitations when applicable.
- Provide urgent scheduling instructions when directed.
- Document the communication and patient response.
Track Referral Progress
Continue monitoring until the referral reaches a documented outcome.
- Confirm receipt by the receiving office.
- Track authorization status.
- Confirm whether the appointment was scheduled.
- Document unsuccessful patient or specialist contact attempts.
- Follow up on urgent referrals more quickly.
- Update the referral status after each action.
Manage the Returned Consultation
- Confirm the specialist report is attached to the correct patient.
- Route the report to the ordering provider.
- Document provider review.
- Enter follow-up orders, medications, or tasks when directed.
- Update the patient’s care plan and relevant history.
- Schedule follow-up when needed.
Complete or Close the Referral
Close the referral only after the final outcome and any remaining work are documented.
- Consultation completed and report received
- Patient declined the referral
- Patient could not be reached after documented attempts
- Insurance denied or redirected the referral
- Provider canceled or replaced the referral
- Patient established with another provider
- Referral remains active with follow-up ownership clearly assigned
✅ Best Practices
- Review referral queues every business day.
- Prioritize urgent and oldest referrals first.
- Verify payer requirements before sending.
- Include complete supporting records.
- Confirm the receiving office actually received the referral.
- Keep each referral assigned to a clear owner.
- Track returned reports through provider review.
⚠️ Common Errors
- Sending incomplete referral information.
- Selecting the wrong specialty.
- Using an outdated fax number.
- Sending to an out-of-network provider without review.
- Failing to document authorization details.
- Closing a referral immediately after transmission.
- Not tracking the specialist report.
- Documenting “referral sent” without date, destination, or method.
⬆️ Escalate Immediately
- An urgent referral cannot be scheduled promptly.
- No in-network specialist is available.
- The payer blocks the referral because TNC or the provider is out of network.
- Authorization is denied for a medically necessary service.
- The receiving office refuses or cannot accept the patient.
- The referral is attached to the wrong patient.
- A serious specialist recommendation is returned.
- RXNT prevents referral transmission or tracking.
Prior Authorization Workflow
1. Verify Requirement
Confirm whether the patient’s plan requires a referral, authorization, or both for the requested service.
2. Submit Documentation
Provide the diagnosis, clinical notes, testing, treatment history, and other payer-required records.
3. Track Determination
Monitor pending requests, requests for additional information, approvals, denials, and expiration dates.
4. Document Outcome
Record the authorization number, approved service, date range, visit limits, denial reason, and next action.
Referral Status Guidance
Pending Information
Additional records, insurance information, provider clarification, or patient information is needed before transmission.
Authorization Pending
The referral cannot move forward until the payer issues a determination or requests additional information.
Sent or Received
The referral was transmitted and receipt was confirmed, but scheduling or consultation is not yet complete.
Scheduled
The receiving office or patient confirmed an appointment date. Continue tracking through completion.
Completed
The patient attended the consultation and the specialist report or documented outcome was received.
Declined
The patient declined the service after receiving sufficient information. Document the reason and notify the provider.
Unable to Reach
Required outreach attempts were documented, the provider was notified, and the next action was determined.
Denied or Redirected
The payer denied, redirected, or limited the referral. Document the reason and route the issue for provider review.
Patient Communication Timeline
Initial Communication
Notify the patient that the referral was placed, explain the purpose, identify the receiving office, and provide scheduling instructions.
Follow-Up Communication
Contact the patient when authorization is approved, additional information is needed, the specialist cannot accept the referral, or the appointment remains unscheduled.
Final Communication
Document the completed appointment, patient refusal, inability to reach, insurance denial, alternate referral, or other final outcome.
Returned Consultation Report
When the specialist report is received, it must become part of the ongoing care workflow rather than simply being scanned into the chart.
- Verify the correct patient.
- Attach or file the report in the correct chart location.
- Route it to the ordering provider.
- Document provider review.
- Complete any new orders or tasks.
- Communicate follow-up instructions to the patient.
Missing Consultation Report
If the patient attended but the report was not received, contact the specialist office and continue follow-up until the record is obtained or the provider directs otherwise.
- Confirm the appointment occurred.
- Verify the specialist’s fax or records contact.
- Request the consultation report securely.
- Document each request.
- Escalate repeated failure to obtain the record.
Documentation Examples
✅ Complete Documentation
Cardiology referral ordered for evaluation of recurrent palpitations. Patient demographics, insurance, office note, current medication list, EKG, CBC, CMP, and TSH attached. UHC network status verified and prior authorization not required. Referral faxed to Desert Cardiology at 11:18 AM; successful transmission confirmed. Patient reached by phone, provided office number and instructed to call within two business days if not contacted. Follow-up task assigned to verify scheduling in seven days.
❌ Incomplete Documentation
Referral sent to cardiology. Patient aware.