A referral is a formal recommendation issued by a physician or healthcare provider to direct a patient to a specialist for further evaluation or treatment. They are crucial for facilitating insurance approvals and managing costs by directing care through your organization's network-preferred providers.

This user guide details the steps to enter all information for a referral request so that it may be submitted for review. Refer to Reviewing a Request for the review and adjudication process.

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* Access to Utilization Management * Permission to create referrals

When you have a prior authorization request for services that needs to be reviewed for medical necessity and provider network requirements.

* The Units Calculator is a time saver to help with calculating the correct number of units to be requested. Refer to [Using the Units Calculator](../using-the-units-calculator.md) for help and guidelines. * The referral workflow can be started from the UM worklist. You will need to search for the person within the request.

Starting point is the CPV of the person for whom the referral is being created.

Click **New Request**.

Select a **Request Category** from the menu.

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### Requester Information (_Optional)_* Enter the **Requester Name**. * Select the **Requester Type**. * Enter contact information: phone, email, and/or fax.

### Request Details* Change the **Classification**, if needed. * Select the **Referral** radio button as the **Request Type**. * Change the **Healthcare Type**, if needed. * Select a **Treatment Setting**. * Select an **Urgency**. * Change the **Request Source,** if needed. * Change the **Notified Date/Time**, if needed. It is automatically set to the current date and time.

Click **Create**.

### Person InformationThe person's demographic and enrollment information is displayed. The individual's primary active enrollment is selected by default.To choose another enrollment, select the radio button for that enrollment.

### Provider InformationA referring and servicing provider are required for a Referral request. Additional providers can be added to indicate their roles and involvement in this service.* Click the drop-down to select the type of search to perform * Enter the search term. * Click +**Add** on the desired provider.

* Select the role for this provider. One role is required for each provider. A provider may have multiple roles on the same request.

* To add more providers, enter a new search term and repeat the same steps. * To delete a provider, click **Remove**. * To add a temporary provider, click **Add Temporary Provider** and refer to [adding-a-new-provider.md](../../../platform-capabilities/adding-a-new-provider.md "mention")

Click **Continue** to go to the Diagnosis and Services page.

### DiagnosesA primary diagnosis is required for all requests. Multiple diagnoses can be added.* Enter the code or keywords for the diagnosis. * Click + **Add** on the desired diagnosis.

* To add more diagnoses, enter a new search term and repeat the same steps. * Click the

icon to indicate the primary diagnosis. * To delete a diagnosis, click the

icon.

### ServicesA single primary service is required for all referrals.* Enter the code or keywords for the service. * Click **+Add** on the desired service.

* Enter the **Duration** of time that the service is to be administered. * Select **Units**. * Manually enter the **From Date** or select from the calendar picker.

The **Through Date** automatically calculates based on the entered duration, units, and from date. Changing any of these adjusts the through date.

* Enter the number of **Units** to be provided within this referral. * Select a unit of measure. * (_Optional)_ Enter modifiers. * Select a **Treatment Type**. * If you search for a different service, you are given the option to replace the one already chosen.

Click **Continue** to move to the **Attachments** page.

### Attachments (Optional)Supporting documents can be attached to the created request. Refer to [#adding-a-file-type-attachment](../management/managing-request-attachments.md#adding-a-file-type-attachment "mention").

Click **Continue** to go to the Review page.

### Review and SubmitReview all details of the request prior to submitting it for review. If you need to make changes, click the

icon to be navigating directly to that section.* Confirm that the request is being assigned to the correct user. Click **Change** to select another assignee.

* Click **Submit** to finalize the information entered and route to the assignee. * (_Alternate)_ Click **Delete Draft** to return to the CPV without saving the referral.

After successful submission of the referral for review, a summary dialog box displays. The automated outcome, if any, is provided.