O-14-124 Process Pending Referral

👤 Responsible Person

Intake Coordinator

🎯 Purpose

This workflow task must be completed timely to create the initial referral that triggers subsequent tasks for eligibility and authorization. This process outlines the minimum requirements to complete to process to the next workflow tasks.

NOTE: Referrals should not be declined during this task as it is important to add the Referral Source prior to the Non-Admit.

🔄 Process

Select Process Pending Referral
Select Edit/View Referral Intake Form

Complete all items with a red asterisk * to save the referral. All tabs across the top of the referral must be completed to move on. The tabs will turn green as they are complete:
1. Basic Info:
  
  Fields should prepopulate based on information selected in external referral request (previous task)
  1. Branch
  2. Team
  3. Last Name
  4. First Name
    
    NOTE: Click Save & Continue to save the information and move to the next tab. Do not close out of the referral without saving.
    
    Demographics:
    
    Basic demographic information required at this stage includes:
  5. Gender
  6. Date of Birth
    
    Demographics - Service Location
    
    (Location where client will be receiving Home Health Services)
  7. If Service Location is listed from External Referral request, select “Edit Service Location”
  8. If Service Location is blank, select “Add Service Location”
    
    Select Service Location Type: generates Q codes on the claim for billing.
    
    Only select one of the following:
    1. Patient’s Home/Residence: defined as wherever client makes his or her home (can be their own home, family member’s residence, group home, etc)
    2. Assisted Living Facility: facility defined as an Assisted Living Facility by the state
    3. Place Not Otherwise Specified: should be used in the rare instance that Home or ALF do not accurately describe the location (for example, patient is homeless)
  9. Enter all required fields. Select the red Pushpin icon📌 to verify the address using Google Maps, move the pushpin on the map if necessary.
  10. Click Save & Close to close out of map
2. Referral Source:
  1. Update date of referral
  2. “Referral Taken By” will auto-populate with user who created the client in HCHB or “Interface” if referral generated in Forcura
  3. Referral Source:
    1. Physician: Referrals issued by a specific ordering provider. Refer to O-11-203 Initiate a REQUEST TO ADD NEW PHYSICIAN
    2. Facility: Most referrals will fall into this category. Includes clinic, ALF, hospital, SNF, county social worker, infusion companies and other home care agencies. Refer to O-11-204 Add New Facility in HCHB if needed
    3. Other: Referrals from family members or individuals with a relationship with the client
  4. Click Save & Continue
    
    Payor Source:
    
    Add known primary payer information. If Medicare MBI is available, only set up Medicare NGS
    
    NOTE: Authorization Specialist will verify, edit and add payors at the appropriate workflow stage
  5. Select Add Payor Source:
  6. Select Payor Type from drop down, then select Payor Source
  7. Complete required fields in Payor Source entry
  8. Indicate Point of Origin
  9. Click Save & Close to save the payor information
  10. Click Save & Continue
    
    Physicians:
    
    Primary Care Provider and shell for F2F encounter (if applicable) must be completed at this stage
  11. Select Add Physician to search the database
    1. If the provider is not in the database, follow the process O-11-203 Initiate a REQUEST TO ADD NEW PHYSICIAN
      
      If MDCR or MA potential primary or secondary payer, select F2F Encounter to create the F2F “shell”:
    2. Select Add F2F Encounter
    3. Enter information if known, otherwise, just select Save & Close to save the “shell”
      
      Diagnoses:
      
      Only the primary diagnosis is required to be entered into the referral at this time.
      
      For PDGM payers, refer to O-13-103 Verify Diagnoses in Decision Health to determine if the Primary Diagnosis meets the PDGM criteria
  12. Select Add Diagnosis
  13. Enter ICD10 Diagnosis Code if known
    
    If specific ICD10 Diagnosis Code is not known, select magnifying glass to search
    1. Enter description of code
    2. Change filter from Home Health (default) to All
    3. Select appropriate diagnosis
    4. Double-click or select Apply Selections
  14. Select Onset/Exacerbation and enter date or select calendar to select date of onset/exacerbation
  15. Select Save & Close
    
    Scheduling:
    
    The anticipated date of SOC and discipline must be completed at this task, but may still be updating prior to scheduling. Entering the anticipated date here helps prioritize subsequent workflow tasks as it will populate in the Workflow Console
  16. Enter the Requested Date of Evaluation and Admitting Discipline
    1. Scheduling Acuity may be selected if known
  17. If additional disciplines are ordered at the time of the referral, select Add-On Evaluations to be associated with the Comprehensive Visit (Maximum allowed is 2 Add-Ons)
    1. Add-On Evaluations should be scheduled as close to the SOC as possible
    2. If SOC is nonbillable due to Therapy Only, Add-On evaluation must be scheduled same day as SOC
      
      NOTE: If more than 2 Add-Ons are ordered, admitting clinician is responsible for including orders at the SOC
  18. Select Save and Continue
    
    Clinical:
    
    The Clinical tab contains no “required” fields to be completed during the “Process Pending Referral” stage. It is the final “tab” in the referral prior to completing the task to send to Eligibility/Auth Coordinator
  19. Verify Demographic/Insurance information has been attached to the medical record:
    1. Select Attachments
    2. Select Patient Attachments
    3. Ensure Demographic/Face Sheet and appropriate insurance information has been attached to the record
  20. Select Save & Close

NOTE: If required information is missing, user will be prompted to go back and enter. Referral will not move on from Pending until all required information is entered

NOTE: If Referral is saved with Evaluation Date entered, but missing information, task will now read as Process Pending Referral – Req Eval Date______

📅 Effective: 03/03/2025 | 🛠️ Revised: 07/18/2025 | ✅ Approved by: JS