A Client is a virtual community in the U. S. exclusive to 250,000 independent specialty physicians. Digital health platform operates as a referral clearinghouse that automatically matches physician availability with appointments required. On the Platform, a client provides explicitly more benefits to primary care providers.
The client wanted to develop an automated digital referral management system for infectious disease management. Primary care physicians can create a referral to other providers who are in-network or out-of-network. Clients can create their preferred provider list and schedule tentative appointments with referral providers.
Thinkitive's business analysts and SMEs took calls to gain a complete understanding of the client's requirements. This information was utilized to describe the solution functionality for creating a Referral module. The thinkitive team has provided a solution for many specialties that assists in securely sending and accepting referrals with all relevant information via an application. It includes referral creation along with the Provider and patient consent. After acceptance by providers, patients can create appointments with referred providers. A Thinkitive team enables Clients to manage referrals, optimize networks, improve care delivery, manage population risk & maximize value-based care performance.
Thinkitive's team delivered the solution with the below features:
1. Providers can create incoming and Outgoing Referral requests to other providers with insurance verification and eligibility checking.
2. Referred Provider can have provision to Accept or Deny referral request.
3. Referring or PCP provider and referred Provider can book an appointment against referral request.
4. Provision to Expand providers' network by adding preferred Provider.
5. The patient can book an appointment with referred Provider after acceptance of the referral request by the Provider.
A referral management system is a robust and remarkable feature in telehealth applications for healthcare providers. It helps to keep track of patient referral data during their treatment time.
Create a Referral Request
The thinkitive team has developed a feature in the telehealth app that allows providers to create an online referral request. PCP can create & send new referral requests to providers & patients.
For creating a referral, PCP needs the patient's basic details & patient insurance details, and It can help the patient and Provider with automated insurance verification in advance. Referring information includes prior authorization, Preferred provider details, ICD -10 code/diagnosis, and the reason for referral.
Primary care physicians can create a preferred providers list with their specialty. We can give preference as per their specialty when providers have multiple specialties. After adding a specialty provider, we can see a list of selected specialty providers, review the Provider's profile & enable it to add to the preferred providers' list.
While creating referrals, we provide options for primary physicians to refer providers from their custom list of preferred providers, or you can manually add provider details. Primary care physicians can book a tentative appointment for patients then physicians can see the Provider's availability and select time slots.
Space for accepting or Deny referral request
As the Provider sends the referral request, the referred Provider receives it. Referred Providers have the provision to accept or deny that referral request.
Scheduled tentative appointment
As the referred Provider has accepted a referral request, PCP or patient can book an appointment with that Provider by selecting the available slot. Also, if a provider does not respond to a referral request, PCP can schedule a tentative appointment with a Referred provider.
Upload clinical documents & E-signing
If required, PCP can upload a patient's clinical documents for reference to the referred Provider to be sent along with the referral request. We have provided a checkbox for e-signing the referral letter.
Centralized Referral Dashboard, Prevent denials and receive decisions sooner
Tentative appointment booking for a patient with a specialty provider
Referral acceptance confirmation via Platform & Enhanced Professional Brand
Keep track of and consolidate existing and historical patient referrals into a central database.
Develop referral workflows, reduce leakage, increase completion rates of referrals, and improve utilization.