REFERRAL TRACKING POLICY *

Effective Date: 
Tue, 08/09/2011
Reviewed: 
Wed, 04/25/2018
Revised: 
Wed, 04/25/2018
Policy: 

The SHC provides referrals for care that cannot be provided at UCSC Student Health Services, or is appropriate to continue elsewhere.

In the case of potentially serious clinical problems that are being referred off campus, the referring clinician may designate the referral to be tracked, (or can set a reminder for themselves).  Examples include referrals for breast masses, rectal bleeding, and skin lesions suspicious for cancer.  Insurance Office personnel will follow up on these referrals designated for tracking and communicate to the referring SHC clinician in a timely manner if the consultation note is not received in 30 days or by the time requested.

Procedure: 

REFERRAL TRACKING PROCEDURE

The SHC provides referrals for care that cannot be provided at UCSC Student Health Services, or care for which it is appropriate to continue elsewhere.

In the case of potentially serious clinical problems that are being referred off campus, the referring clinician may designate the referral to be tracked by an insurance advocate.  Examples of serious clinical problems include referrals for breast masses, rectal bleeding, or skin lesions suspicious for cancer.  The Insurance Office advocate will monitor referrals designated for tracking and communicate their status to the referring SHC clinician in a timely manner if the consultation note is not received in 30 days or by the time requested by the clinician.

REFERRAL TRACKING PROCEDURE

Clinician initiates outside referral in the electronic medical record and indicates the request for tracking assistance by clicking TRACK as the Urgency preference.  If the clinician forgets to designate tracking prior to signing the referral, they will compose an instant message to the Insurance Office staff requesting tracking of that individual referral.

Clinician sends the patient to the Insurance Office.  The insurance office reviews the following: basic information on insurance coverage for specialty care, process of sending referral to appropriate specialists, how the patient and the specialist will communicate and expected time-line for specialty appointment.  .

Insurance Office advocates track referrals in the following way:

Four weeks after the referral is generated the insurance advocate checks for a report of visit from the specialist. 

If the outside consultation report has been scanned into the medical records document section and acknowledged, no further tracking is required.

If the report has been scanned but the clinician has not acknowledged the report, an instant message is sent to the ordering clinician indicating that the report has come in.  Once the clinician is notified of the referral report, no further tracking is required by Insurance..

If after 4 weeks no report is found by in the EMR, the insurance office personnel will call the student to confirm that the consultation/test has been completed.

If the consultation occurred but no report is received then the Insurance advocate will phone or fax the consultant, requesting that the written report be faxed to SHC.   The advocate will call or fax a request once a week for three weeks to try to obtain the report.  The Insurance office personnel can fax a "Continuity of Care" Medical Records Request as a reminder. If three attempts at contacting consultant office have failed to produce report, the referring SHC provider is notified of no response from consultant.  No further tracking is indicated.

In no consultation occurred because the student has not been seen then the insurance advocate will offer to assist the student with scheduling the consultation.  If three attempts to assist the student to access services have been attempted (by the insurance office or the specialist offices) and the student has still not followed through, the clinician is notified and no further tracking is indicated.    Insurance office personnel should document conversations with student and IM the clinician if student has not scheduled or completed recommended referral services.