RS reviews info from physician and insurance information on patient chart. She checks to see if patient needs written referral to see a specialist. If patient needs written referral to see a specialist, RS will check to see if the particular condition which the patient is referred simply needs a referral form completed, or whether a phone call is necessary to the insurance company. For certain procedures, such as an expensive test like the MRI, or when an urgent referral is necessary, RS may need call the insurance company to request an authorization number. It often takes several attempts to get to the right person or get the approval.
RS then checks to see if the specialist is in the patient's health plan.
R.S. then completes a referral form which is specific to that insurance company. Information needed usually includes the date, patient's name, social security number, insurance information, provider name, provider I.D. number, name of physician being referred to with address, phone number, specialty, any limitation on the referral such as number of visits, duration referral is good for, procedures that are authorized, comments on the diagnosis with appropriate diagnostic ICD codes. The completed referral form with the patient chart is then sent back to the physician. The physician reviews the referral form to make sure that the information entered by RS is correct. Changes are made if necessary.