Referral Management for Community Health Centers
A closed-loop, five-step referral process — from intake and insurance authorization through specialist scheduling, tracking, and the report coming back into your EHR.
Where referrals fall out of the loop
An open referral is not a data problem. It is an ownership problem: each handoff between the health center, the payer, the specialist, and the patient is a place where the referral can stop moving and nobody is accountable for restarting it.
- Referrals sit in a worklist nobody owns after the person who owned it left
- Authorizations expire before anyone notices, and the process restarts
- Patients are booked but never confirmed, so the no-show is discovered on the day
- Specialist notes arrive by fax and never reach the chart or the PCP
Five steps, one owner, every referral
Intake & Verification
Demographics, insurance, and provider documentation are checked before the referral moves, so it is not rejected days later for a missing field.
Insurance Authorization
Submission to the payer — Medicaid, Medicare, or commercial — with the documentation each plan expects, and follow-up until a decision is returned.
Specialist Scheduling
Appointment booked with the specialist, including transportation and language support when the patient needs it.
Ongoing Tracking
Every open referral is monitored, so bottlenecks are found while they can still be fixed rather than at the next audit.
Follow-Up & Integration
Specialist reports come back to the health center, are uploaded into the EHR, and the primary care provider is notified. The loop closes.
The workflow is governed by the standards in How We Work. Authorization and patient-information handoffs follow our Compliance protocols. The same team can also cover your call center and medical records.
How many referrals are open right now?
If the honest answer is "we are not sure," that is the place to start. We will walk the loop with you.