Managing a referral

2. Click the patient name to select a case.

• If you've moved off of the Referral Management view, click manage.

 Responding to a referral request

1. Click ⋮ to the right of the referral status, and then click the appropriate option on the listoption on the list. The notification popup displays.

   Current status is...	Status change you can make
   New	Receive Referral - you have seen and are considering the referral
   	Accept Pending - you can take the patient, pending additional information
   	Offered - you will take the patient
   	Deny Referral - you cannot take the patient under current circumstances
   Received	Accept Pending - you can take the patient, pending additional information
   	Offered - you will take the patient
   	Deny Referral - you cannot take the patient under current circumstances
   Accept Pending	Offered - you will take the patient
   	Deny Referral - you cannot take the patient under current circumstances
   Offered	Cancel Referral - you offered and then canceled the referral
   Canceled	Accept Pending - you can take the patient, pending additional information
   	Offered - you will take the patient

2. If you're denying or canceling the referral, click to select a reason from the drop-down listreason from the drop-down list.

   Home care / hospice reasons for denial	Definition
   Non Clinical - Geography	Patient's residence is outside the service area
   Non Clinical - Active with another home care provider	Patient is already receiving service from another home care provider
   Clinical - Exceeds clinical capabilities	Not able to meet the patient's clinical needs
   Clinical - Not Homebound	Patient does meet level of care, not homebound
   Clinical - Program not offered	No clinical program to meet the patient's needs
   Clinical - No Skilled Need	Patient does not meet level of care
   Clinical - Supply / Medication availability	Not able to accommodate the patient's needs because of access to meds or supplies
   Clinical - Staffing Availability	Not able to accommodate the patients needs because of staffing
   Clinical - No following community physician	No provider to follow patients when on service or post service
   Clinical - Safety Concerns for provider	Safety concerns for providers not SUDs
   Clinical - Safety Concerns for patient	Safety concerns for patient not SUDs
   Clinical - Safety Concerns Active SUD	Safety concerns specific to active SUDs
   Clinical - Psychiatric services not available	Do not provide the needed psychiatric services
   Clinical - History of non adherence with care plan	Patient has a history of non compliance with care plan
   Financial - Not a contracted or preferred provider	Home Care provider is not a preferred provider for patient's insurance or not a contracted provider
   Financial - No insurance benefit (including uninsured)	Patient's insurance has  no home care benefit or patient is uninsured
   Financial - Insurance denied authorization	Patient's insurance denies coverage
   Inpatient post-acute reasons for denial	Definition
   No Bed Available - Precaution	Not at capacity, but cannot accommodate patients cohorting needs.  Could be COVID or other ID
   No Bed Available - Sex	Not at capacity, but don't have a bed available with for gender matching room
   No Bed Available - at building capacity	The facility is at capacity and not able to accept any patients
   No Bed Available - at risk of LTC	The facility cannot / is not admitting Long Term Care Patients
   No Bed Available - secure unit	The facility does not have a secure unit and/or no secure bed available
   No Bed Available - Staffing	The facility is not able to accept patients because of staffing limitations
   No Bed Available - at program capacity	The specific program (e.g.: pulmonary) is at capacity
   Clinical - Exceeds Clinical Capabilities	Facility is not able to meet the clinical needs of the patient
   Clinical - Does Not Meet LOC guidelines	Patient is not an appropriate level of care for the facility
   Clinical - Facility does not provide clinical program	No clinical program for the patient
   Clinical - Behaviors	Facility cannot adequately care for the patient's behavioral needs
   Clinical - SUDs	No prescriber or access to SUDs clinic for meds
   Clinical - Psychiatric Needs	Facility not equip to care for the patients psychiatric needs
   Financial - no insurance benefit for  Level Of Care	Patient has no insurance for this LOC
   Financial - no MCR qualifying stay	Patient has no qualifying stay for this LOC
   Financial - no long-term payer source	Patient does not have insurance in place to cover custodial care
   Financial - Not Contracted/Not Preferred Provider	Facility is not a preferred provider for patient's insurance or not a contracted provider
   Financial - Uninsured	Patient has no insurance
   Financial - No Secondary Payer	Patient has no secondary payer
   Financial - Insurance Denial	Insurance denied approval for admission
   Financial - Cost exceeds reimbursement	Cost exceeds reimbursement
   Other - Housing Insecurity or no DC options from LOC	Patient Homeless, unable to return to current living environment
   Other - Transportation issues (e.g.: HD, chemo)	Patients needing transportation coordination during SNF admission
   Other - Escalated and denied by Administration	Admissions escalated to leadership
   Other - Sex Offenders	Patient is a Level 3 and facility is unable to accept the referral
   Other - Patient actively using (SUD)	Patient with SUD, actively (or recently) using

• Denying the referral or canceling the offer inactivates the referral.
• Denying a referral or canceling an offer automatically removes any patient documents and attachments from the referral.
• Messaging is allowed after the referral is canceled or denied. To see new messages for these inactive referrals, add the applicable Status filter(s) to your Referrals Received list (there are limits to what referrals you'll see). To see all referrals without limitations, see Searching for a patient history.

3. The text is pre-filled with an applicable message. Type to make changes or additions as needed.

• Setting the status to Received is a good response if there is a temporary situation that prevents you from accepting or offering at this time. An example is when there's currently no bed available, but one could open up by the time the patient is discharged. Describe the situation in the message.
• If you are setting the status to Accept Pending, describe the information that you're waiting for.

4. To flag the message as requiring immediate action, click  to turn the Priority switch on: .

5. Click send. The message is added to the  Communicatons thread.

Changing Offered to Accept Pending

If you Offered by mistake, cancel the referral, then update status to Accept Pending. When you accept pending, you'll see the documents and attachments that were previously shared.

1. Click ⋮ to the right of the referral status, and then click the Cancel Referral option The notification popup displays.
2. Select a reason from the drop-down list. (The sender does not see this.)
3. Update the message text to say "We are cancelling this offer. We will set to Accept Pending instead."

4. To flag the message as requiring immediate action, click  to turn the Priority switch on: .

5. Click send. The message is added to the  Communicatons thread.