How to request an Internal Referral

An internal referral is when a CMO/ACP is requesting that an Atria specialist perform a consultation and/or test on the member. External referrals are when the requested clinician is not part of the Atria staff. For external referrals we use referral orders in the system because it generates a document that gets sent to the outside clinician. For internal referrals, we don’t need that functionality and the goal is a process that standardizes the communication between the CMO/ACP and the specialist or their Care Coordinator in a way that minimizes errors, increases transparency, and is HIPAA-compliant. For this reason, all internal referrals requests should be communicated via a Patient Case. This document will show you how to request an internal referral. The highlighted services in the table below require approval which slightly changes the process and will be detailed specifically at the end of the document.

The following table shows where to send the Patient Case by internal referral type:

• New York

• Palm Beach

To request an internal referral that does not require approval:

1. From the member’s chart click on the “hamburger” and select “Create patient case”.

2. Please use the dropdown boxes to select “Specialist” for Source/Recipient and “Clinical Question” for Type. Provider is a mandatory field. If requesting Metabolic Testing choose Nieca Goldberg. If not, choose a clinician that provides the service you are requesting. If there are more than one option, for example neurology, select any of the clinicians (if you specifically want your member to only see one of the clinicians please specify that in the Case Description - step 3).

NOTE: If you don't see the name of the specialist, switch your Department to NY - Atria institute

3. In the “Subject” please enter the referral type you are requesting. In the “Case Description” please give clinical context as to why you are requesting the referral. For example, for a physical therapy referral you should provide at a minimum the joint or joints that need treatment, if an injury or recent surgery led to the current state, what is the goal of therapy (pain reduction, range of motion, etc), and any restrictions. Please provide as much context as possible, if the context is not adequate, the Care Coordinator may send the Patient Case back to you to ask for specific information that is necessary to plan for the consultation.

4. Scroll down and click the “Save” button.

5. The Patient Case will be sent to the Inbox of the clinician indicated in the “Provider” section of step 2 and may need to be redirected to a care coordination Inbox if approval is not required. Please use the table above to determine which inbox to use (as indicated in the 2nd column titled "Send Patient Case to"). To send the Patient Case to the appropriate inbox, scroll to the bottom, change the name in the “Leave in review to” box to the appropriate Inbox from the table and press the “Save” button.

6. Make sure the status is “in REVIEW to [appropriate Inbox]”.

If additional information is requested, the Action Note will be used to ask and respond to questions. To reply to the sender with an Action Note simply type the message in the Action Note section, click Reply to Sender, and press the “Save” button.

The consults that require approval (in yellow on the above table)

To request them, follow the above steps 1-4 above selecting the clinician in the “Provider” section of step 2. The additional steps are not necessary, just make sure the status is “in REVIEW to” the physician's Inbox to assure that they get the request.

If the request is denied, they will reply to you via the Patient Case with their justification in the Action Note. If the request is approved, they will forward the Patient Case to the appropriate CC Inbox for scheduling.