Referral Routing
Read referrals, check completeness, and route them to the right service without manual sorting.
What It Does
The agent reads each referral, checks it against requirements, flags what is missing, and routes it to the right service for confirmation.Without it: Referrals arrive incomplete and unsorted, so patients wait and staff chase missing information.
- Handles faxed PDFs, portal submissions, and direct messages in one queue
- Matches the request to an accepting provider by sub-specialty and location
- Hands the accepted referral to scheduling with its prep requirements, and books nothing itself
- Leaves out-of-network and ambiguous referrals in an exceptions queue untouched
Illustrative example
A cardiology referral comes in by fax without the recent ECG the service requires. The agent matches the patient to an existing chart, routes it to the cardiology queue with the ECG listed as the one outstanding item, and parks a second referral, for a sub-specialty the directory has no accepting provider for, in exceptions. Intake staff make one phone call for the ECG and one placement decision.
Referral inbox
Faxes, portal messages
EHR
Matching patient chart
Provider directory
Accepting providers, sub-specialty
Scheduling system
Service prep requirements
Referral routing
ExecuteStarts when
A referral arrives by fax, portal, or direct message
How far it goes
it acts inside set limits, and every call is logged
Completeness checks
Run on every referral
Missing-info flags
Listed on the referral
Service routing
Routed, nothing booked
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Assemble prior-authorization requests against payer rules, ready for a clinician to review and submit.
Clinical-note summarization
Draft encounter summaries from the record, cited and masked, for a clinician to confirm.
Claims adjudication support
Read claims and supporting documents, check them against policy, and prepare a decision for review.
