Chapter 11: Patient Referral
This chapter covers sending a patient to another provider. It defines the referral request and the replies that accept, decline or return it.
This chapter covers referrals. A referral is one provider asking another to take over part of a patient's care. It covers the request, and the replies that accept, decline or return it. The main message type is REF. The RF1 segment carries the referral.
What is in this chapter
- 9 trigger eventsthe real-world things that cause one of these messages to be sent
- 4 segmentsthe lines these messages are built from, and the fields on each
- 9 code tablesthe value sets the fields in this chapter draw from
- 13 message typesPIN, RCI, RCL, REF, RPA, RPI, RPL, RPR, RQA, RQC, RQI, RQP, RRI
Message types defined here
PINPatient insurance informationNamed by the standard without a structure of its own.
RCIReturn clinical information1 structure, fired by 1 trigger event.
RCLReturn clinical list1 structure, fired by 1 trigger event.
REFPatient referral1 structure, fired by 0 trigger events.
RPAReturn patient authorization1 structure, fired by 0 trigger events.
RPIReturn patient information2 structures, fired by 2 trigger events.
RPLReturn patient display list1 structure, fired by 1 trigger event.
RPRReturn patient list1 structure, fired by 1 trigger event.
RQARequest patient authorization1 structure, fired by 0 trigger events.
RQCRequest clinical information1 structure, fired by 2 trigger events.
RQIRequest patient information1 structure, fired by 4 trigger events.
RQPRequest patient demographics1 structure, fired by 1 trigger event.
RRIReturn referral information1 structure, fired by 0 trigger events.
Segments defined here
These 4 segments are defined in chapter 11. Messages in other chapters may still carry them.
AUTAuthorization Information SegmentCTDContact Data SegmentPRDprovider data segmentRF1Referral Information Segment
Trigger events
A trigger event is the thing that happens in the hospital and causes a message to be sent. Chapter 11 defines 9 of them.
I01Request for Insurance InformationI02Request/Receipt of Patient Selection Display ListI03Request/Receipt of Patient Selection ListI04request for patient demographic dataI05Request For Patient Clinical InformationI06Request/Receipt of Clinical Data ListingI07Unsolicited Insurance InformationI08Request for Treatment Authorization InformationI12Patient Referral