5 No-No’s for Sending A Referral

• June 01, 2021
• Jesse Smith
• Uncategorized

When a patient has a complex, chronic condition, it takes a whole village of providers, specialists, pharmacists and more to support a patient’s overall health. Nurses and Medical Assistants can spend a lot of their time referring patients to those healthcare partners.

Whether they are recently diagnosed or beginning a new therapy, a quick and smooth referral process is critical to making sure nothing slows down or hinders a patient’s journey to feeling better. And who has time to make or answer numerous extra phone calls? Our patient intake experts offer five key tips to make sure your referral process saves you time and prevents unwanted, extra administrative follow up

1. Sending an insurance card that is difficult to read

Take the best possible quality picture of a patient’s insurance card when you send it to the specialty pharmacy. Having every available piece of information on the card, both front and back, will potentially save the specialty pharmacy hours of time, which in return saves you time. It will also eliminate any potential phone tag looking for missing pieces of information.

If the picture or fax of the insurance card isn’t clear, handwrite the information on the referral form or a separate piece of paper. Be sure to include Member Identification Number, BIN, PCN, GROUP numbers, and the best phone numbers for the policy.

2. Not including a diagnosis code

A specialty pharmacy needs critical pieces of clinical information in order to advocate and research on behalf of the patient and prescriber. One of the most important pieces of information is the diagnosis code. Almost all medications are approved or denied based on the condition for which they are being prescribed.

Without an accurate diagnosis code, an insurance company may delay or deny coverage approval. Having the diagnosis code can also enable the specialty pharmacy to research financial assistance options available for that specific patient population. Many grants and assistance funds are categorized and accessible based on diagnosis.

3. Skimping on the demographics

Along with the diagnosis code, be as thorough as possible when filling out the all of the patient’s demographics. Don’t assume a pharmacy will be able to get ahold of a patient to fill in the blanks. Often times, patients don’t answer unknown numbers and they might not yet know why a specialty pharmacy is calling for such sensitive information.

While also following all HIPAA guidelines, those pieces of information allow a pharmacy to do a full and proper benefits investigation on behalf of the prescriber’s office and the patient. Without them, a pharmacy representative will not get very far on the phone with an insurance company.

4. Forgetting the prescriber’s signature

As with most medical documentation, a referral is just a piece of paper until it has a prescriber’s signature. If medications and dosages were included when referral was submitted, the provider’s signature is what makes the referral a legal, valid prescription. If a prior authorization (PA) is required, the referral can be used to initiate the PA – but only if a licensed provider has signed it.

5. Not sending the supporting documentation

If the medication prescribed for a patient is not going to require a prior authorization, an E-scribe, or electronically signed legal prescription, will suffice. However, if a prior authorization is anticipated, we recommend faxing in a hand written prescription with the patient’s recent medical records and the completed referral form.

Sometimes, the manufacturer’s referral form is recommended because it helps enroll patients in any copay assistance or free drug programs that are handled by the manufacturer. Sending the recent medical records help a specialty pharmacy succinctly fill out any and all qualifying questions a payer may have to get a medication approved.

Amber Specialty Pharmacy offers a worry-free referral process, supported by thorough and timely communication with an intake team that works diligently to get patients to therapy as soon as possible. Check out our fillable referral forms here and reach out today to see how easy it can be to work with a specialty pharmacy that puts you and your patients first.