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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 [ ... ]

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