System for referral management
AssigneePayoda Technology Inc.
InventorAnand Purusothaman
Life of this patent
Estimating the term…
Abstract
A system for referral management is provided. The referral management system includes a multi-channel referral consolidator, an inbound referral queue, a communication engine, a workflow engine, an integration engine, a referral analytics module, a report engine, and a management module. The referral management system generates a virtual network between key actors of the referral ecosystem which includes a referral provider, a plurality of patients and a plurality specialist. The referral management system consolidates referrals from multiple sources, facilitates effective communication and exchange between key actors of a referral ecosystem and coordinates end to end referral process till referral closure.
Claims16
A system for managing at least one referral and automatically generating and prioritizing a referral queue to process follow-up and close the at least one referral in a health care-environment, the system comprising:
- a memory that stores a database, wherein the database includes referral information associated with the at least one referral;
- and
- a processor that is configured to:
- enable the system to receive the at least one referral from at least one of (i) a referral provider via a referral provider device or (ii) a user via a user device;
- validate the at least one referral to identify a type of the referral and communicate to the referral provider;
- receive at least one specialist determined by the referral provider based on the type of the at least one referral;
- communicate the at least one referral to the at least one specialist;
- perform a prioritization based on requirements of the at least one referral by analysing the referral information associated with the at least one referral to automatically generate the referral queue, wherein the referral information comprises at least one of patient demographics, clinical information, clinical charts, a reason for a referral, details of a specialist or referral provider details, wherein the referral information associated with the at least one referral is retrieved from the database based on the referral queue, and external information associated with the at least one referral is automatically searched and retrieved from at least one external database when the at least one referral requires the external information associated with the at least one referral;
- determine the at least one action based on the requirements of the at least one referral by generating a report that populates a template using at least one of (i) the referral information associated with the at least one referral or (ii) the external information associated with the at least one referral;
- automatically perform an insurance pre-authorization process and schedule an appointment request by coordinating with a specialist office and a patient based on the requirements of the at least one referral;
- generate a patient follow-up letter for the appointment request and mail the patient follow-up letter to the patient;
- communicate with the referral provider on additional information required on the at least one referral and update a specialist office about patient appointment;
- follow-up with the specialist office on the referral status after the patient appointment;
- and
- validate the report and complete or close the at least one referral.
A method for managing at least one referral and automatically generating and prioritizing a referral queue to process follow-up and close the at least one referral in a health care-environment, the method comprising:
- receiving the at least one referral from at least one of (i) a referral provider via a referral provider device or (ii) a user via a user device;
- validating the at least one referral to identify a type of the referral and communicating to the referral provider;
- receiving at least one specialist determined by the referral provider based on the type of the at least one referral;
- communicating the at least one referral to the at least one specialist;
- performing a prioritization based on requirements of the at least one referral by analysing the referral information associated with the at least one referral to automatically generate the referral queue, wherein the referral information comprises at least one of patient demographics, clinical information, clinical charts, a reason for a referral, details of a specialist or referral provider details, wherein the referral information associated with the at least one referral is retrieved from the database based on the referral queue, and external information associated with the at least one referral is automatically searched and retrieved from at least one external database when the at least one referral requires the external information associated with the at least one referral;
- determining the at least one action based on the requirements of the at least one referral by generating a report that populates a template using at least one of (i) the referral information associated with the at least one referral or (ii) the external information associated with the at least one referral;
- automatically performing an insurance pre-authorization process and scheduling an appointment request by coordinating with a specialist office and a patient based on the requirements of the at least one referral;
- generating a patient follow-up letter for the appointment request and mail the patient follow-up letter to the patient;
- communicating with the referral provider on additional information required on the at least one referral and updating a specialist office about patient appointment;
- following-up with the specialist office on the referral status after the patient appointment;
- and
- validating the report and completing or closing the at least one referral.
Dependencies are inferred from the claim text.