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What is a Clinic Referral Nurse?

When patients receive a referral from their provider for testing at another facility or to see a specialist, the referral nurse at Adair County Medical Clinics will help set up those appointments for our patients.

When necessary, the referral nurse will contact the patient’s insurance provider to ensure that the specialist is “In Network” prior to making the official referral.  This includes contacting the insurance company to get prior authorization or verifying by website before scheduling with the specialist or testing facility.  In some cases, it can take up to 16 business days for the insurance company to grant a prior authorization.  If the prior authorization for the referral is denied by the insurance company, the referral nurse will contact the insurance company again and provide further documentation or conduct a peer-to-peer phone call.  In some cases, the insurance company requests other testing before prior authorization can be granted.  An example of this would be an order for an MRI, but the insurance company requests x-rays prior to giving authorization for the MRI.

The referral nurse will also fill out any referral forms the specialist requires and send supporting records to the specialist or testing facility.  After reviewing the patient’s records, the specialist or testing facility will contact the patient to set up their appointment.

We do our best to get testing or referrals done as quickly as possible to accommodate every patient.

 

Michelle Schlicte, LPN

Referral Nurse

Adair County Medical Clinics

The information provided on the Adair County Health System’s Blog is not a substitute for professional medical advice and care. If you have specific needs, please see a professional health care provider. Any references to products, services, or health care providers on this web site are not a recommendation or endorsement of products, services or providers. Links to other Web sites from this site are provided for convenience and do not constitute or imply endorsement. Effort is taken to insure accurate information, however we cannot guarantee completeness or timeliness.

 

 

 

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