PiMS Referral Tracking offers an organized, seamless approach to managing this ever increasing requirement. PiMS allows for both inbound and outbound referrals (Service Requests) as well as authorizations for both. Referral tracking is integrated with PiMS Scheduling to track the remaining number of visits on appointments that require authorization.

Referral/Authorization Policy

PiMS provides an online view of the insurance's referral and authorization policy.

Referrals

Referrals are requests for services for the physician, specialty or clinic.  Referrals can be entered on patients prior to registering the patient and assigning a permanent patient ID. PiMS keeps track of the status of the referral (entered, canceled, consult/chart notes received), as well as reason, referred to physician, referred from physician, specialty or procedure, requested services (up to 4 CPT4 codes), and diagnosis codes.

Service Requests

Service requests are requests for services being made by the physician (outbound referrals).  Service Requests can be entered for the patient prior to authorization. PiMS keeps track of the status of the referral (entered, canceled, consult/chart notes received), as well as reason, referred from physician, referred to physician, specialty or procedure, requested services (up to 4 CPT4 codes), and diagnosis codes.

Authorizations

Authorizations can be tracked for both referrals and service requests. PiMS keeps track of the status (entered, approved, denied, requested) of the authorization along with the authorization number, effective dates, number of visits/days (inpatient), and contact information.

To track authorizations that are pending, PiMS allows the user to indicate a follow-up date. Notes on the authorization can also be entered.

PiMS can track authorizations for three (3) insurances. PiMS provides a variety of views to assist you in managing authorizations. Authorizations can be viewed by follow-up date and third party ID. The views can be further limited by status and effective from/to dates.

Authorization Documents

Scanned authorization and referral documents are stored online for instant access.

Authorization Extensions

PiMS allows for five (5) extensions. Date of extension, who authorized the extension, number of visits/days, effective from/to dates are kept in the extension history. Once the extension is entered, the addition visits/days are available for scheduling.

Remaining Visit Tracking

PiMS tracks the number of remaining visits. When an appointment that requires authorization is scheduled, PiMS decrements the remaining visits.  If the appointment is later canceled, PiMS adds back to the remaining visits.

Scheduling

Authorization is not always required for an appointment. You specify by appointment type if an authorization is required. Optionally, you can specify the authorization is only required by specific insurance companies.

You can also indicate if the authorization can be overridden at the time of scheduling. This allows you to schedule an appointment prior to getting the authorization. PiMS provides a view of all appointments with overridden or held authorizations.

During scheduling, if an authorization is required, a list of active referrals with remaining visits is presented. The user selects the correct referral, holds or overrides the referral (if allowed).  When the appointment is scheduled, PiMS decrements the remaining visits.