Referral Page

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Referral Page

You can use the Referral page to add and edit referral requests for services.

The Referral page contains the following panels:

Referral
Member
Requesting Provider
Status
Alerts
Referral Services
Referred Services Provider
Extended Services (when referral type is PCCM)
Extended Services Provider
Diagnosis
Claim Updates
Letters & Responses
Referral Exceptions

You can open or close certain panels. Click (the plus sign) beside a panel to open the panel. Click (the minus sign) to close the panel.

Certain fields are only available when you are editing.

Referral Fields

Field	Description
Referral ID	A unique identifier assigned to the SA request by ND MMIS. Automatically displayed.
Submitter ID	Unique identifier for the external entity that submitted the SA. This field does not apply to SA requests that are entered internally.
Referral Type	The type of referral. Examples: CSP, PCCM, Other Referral - Dental The referral type determines what fields are displayed.
Begin Date	The date the provider requested the service to begin.
End Date	The date the provider requested the service to end.
Last Saved User	The user who last saved the referral. Automatically displayed.
Assigned User	The user to whom the referral is currently assigned. Automatically displayed.
Current Location	The work location assigned to the referral request. Automatically displayed.
Entered Date	The date the referral was received into the ND MMIS. Automatically displayed.
Entered By	The user ID of the person that entered the referral. Automatically displayed.
Received Date	The date the referra; was received by ND Department of Human Services.
Referral Media Type	Indicates what medium was used to transmit the referral. Examples: Paper, Fax, Web

Member Fields

Field	Description
Member ID	A unique identifier assigned to a member. After a claim is applied to the SA, the Member ID field cannot be changed.
To quickly search for a member, click . When found and selected, the member fields are automatically populated.
Last Name	The member's last name.
First Name	The member's first name.
MI	The member's middle initial.

Requesting Provider Fields

Field	Description
Provider ID	Unique identifier used for a provider of health care services. Format: Up to 15 alphanumeric characters.
To quickly search for a provider, click . When found and selected, the provider ID fields are automatically populated.
Medicaid ID	First supplemental provider ID of requesting provider.
Other Provider ID Type	The type of provider ID. Examples: Medicaid, National Provider ID (NPI)
Other Entity Code	Code identifying an organization entity, a physical location, property, or an individual. Examples: Attending Physician, Primary Care Provider, Service Location
Entity Type	The type of organization, institution, or individual. Examples: Person, Non-Person
Provider Code	Unique code indicating the type of requesting provider. Example: RF-Referring
Taxonomy Code	The 10-digit/alpha taxonomy code of the provider. CMS defines the Taxonomy Codes as an administrative code set for identifying the provider type and the area of specialization for all health care providers. The code set is used in X12-278 Referral Certification and Authorization and the X12 837 Claim transactions. It is maintained by the National Uniform Claim Committee (NUCC).
Provider Name	The full name of the requesting provider. Automatically displayed .
Used	Indicates which requesting provider was used. This field is automatically populated during claims adjudication.
Address	Lines 1 and 2 of the address where the requesting provider is located. Automatically displayed.
City	The city where the requesting provider's address is located. Automatically displayed.
State	The state where the requesting provider's address is located. Automatically displayed.
Zip	The zip code and extension where the requesting provider's address is located. Automatically displayed.
Additional Requesting Provider Information Fields
Org/Last Name	Organization or last name of the additional requesting provider.
First Name	First name of the requesting provider.
MI	Middle initial of the requesting provider.
Suffix	Suffix of the provider. Examples: Jr. Sr. III.
Address	Lines 1 and 2 of the address where the requesting provider is located.
City	The city where the requesting provider's address is located.
State	The state where the requesting provider's address is located.
Zip	The zip code and extension where the requesting provider's address is located.
Country	The country where the requesting provider's address is located.
Country Subdivision	An international standard code that subdivides a country into administrative divisions; such as states, provinces, or territories.
Contact Information Fields
Name	The full name of the contact person for the requesting provider location.
Phone #	The phone number of the contact person.
Ext	The phone extension of the contact person.
Fax #	The Fax number of the contact person.
E-mail	The email address of the contact person. Example: johnqpublic@anywhere.com
Additional Requesting Supplemental Provider ID Fields Up to 8 occurrences of additional requesting supplement provider information can be entered. One of these occurrences may be the Medicaid ID found in the beginning of the Requesting Provider panel.
Supplemental Provider ID	Unique code that indicates the type of supplemental provider ID entered. Examples: 1D-MedicaidID, EI-EIN, 1J-FacilID, SY-SSN, XX-NPI, ZH-CarrNum
Provider ID Type	Unique code that indicates the type of provider ID entered. Examples: DEA, NPI, SSN/EIN
Provider Name	The organization or full name of the supplemental provider.
Used	If checked in the table, the requesting supplemental provider was used by the patient. This field is automatically populated during claims adjudication.

Status Fields

Field	Description
Referral Status	The status of the referral request. Examples: Pending, Approved, Denied, Voided After claims are applied to the referral request, the status cannot be changed to Voided.
Reason for Denial	The reason the referral was denied..
Status Change Date	The date of the status change.
Assigned User ID Override	Assigns the referral to the user selected. After you save the request, the Assigned User field is updated with what you enter here and this field is cleared.

Alerts Fields

Field Name	Description
To add a new alert, click Add Alert. To edit, in the Alerts table, click the appropriate row.
Due Date	The date when a user should respond to an alert. The user changes the status to Completed.
Alert Type	The kind of alert, such as an appointment, reminder, or approval.
Description	Explanation of what the alert is about.
Notify Via Alert	The name of the user to receive the alert.
Status	The status of an alert, such as Open or Closed.

Referral Services Fields

Field	Description
Status	The status of the service.
Service Requested	The specific service requested based on the type of referral. Examples: Hearing Aids, Outpatient Hospital Services
Begin Date	The beginning date of service.
End Date	The ending date of service.
Service Code	The revenue or procedure code for which the referral is submitted. Automatically displayed.
Service Code Type	The revenue or procedure code for which the referral is submitted. Automatically displayed.
Service Code Description	The short description of the code. Automatically displayed.
Number of Referral Visits	The requested number of visits for this service.
Frequency Period	The period of time within which the number of referral visits are performed. Examples: Every 3 Days
Service Duration Count	The time period of the service. Examples: For 21
Remaining Visits	The remaining number of visits left for the service

Referred Services Provider

Field	Description
Referred Services Provider Summary Up to 10 occurrences of referred provider data can be entered.
Medicaid ID	First supplemental provider ID of requesting provider.
Other Provider ID	Unique identifier used for a provider of health care services. Format: Up to 15 alphanumeric characters.
To quickly search for a provider, click . When found and selected, the provider ID fields are automatically populated.
Other Provider ID Type	The type of provider identifier being used for the authorization. Example: Medicaid, NPI (National Provider ID)
Taxonomy Code	The 10-digit/alpha taxonomy code of the provider. CMS defines the Taxonomy Codes as an administrative code set for identifying the provider type and the area of specialization for all health care providers. The code set is used in X12-278 Referral Certification and Authorization and the X12 837 Claim transactions. It is maintained by the National Uniform Claim Committee (NUCC).
Entity Code	Code identifying an organization entity, a physical location, property, or an individual. Examples: 71-AttendPhys (Attending Physician), 77-SvcLoc (Service Location), SJ-SvcPrv (Service Provider)
Provider Name	The full name of the referred provider.
Provider Code	Unique code indicating the type of referred provider. Automatically displayed after the referral is saved.
Used	If checked in the table, the referred provider was the servicing provider. This field is automatically populated during claims adjudication.
Additional Referred Provider Information Fields These fields are the same as those found in Requesting Provider panel, except that the descriptions are about the referred provider.
Contact Information Fields These fields are the same as those found in Requesting Provider panel, except that the descriptions are about the referred provider.
Additional Referred Supplemental Provider ID Fields Up to 8 occurrences of additional referred supplemental provider information can be entered. One of these occurrences may be the Medicaid ID found in the beginning of the Requesting Provider panel.
Supplemental Provider ID	Unique identifier used for a provider of health care services. Format: Up to 15 alphanumeric characters.
Provider ID Type	Unique code that indicates the type of provider ID entered. Examples: DEA, NPI, SSN/EIN
Used	If checked in the table, the referred provider was the servicing provider. This field is automatically populated during claims adjudication.
License State	The state in which the referred provider is licensed.

Extended Services Fields

Field	Description
Status	The status of the service.
Service Requested	The specific service requested based on the type of referral. Examples: Hearing Aids, Outpatient Hospital Services
Begin Date	The beginning date of service.
End Date	The ending date of service.
Service Code	The revenue or procedure code for which the referral is submitted. Automatically displayed.
Service Code Type	The revenue or procedure code for which the referral is submitted. Automatically displayed.
Service Code Description	The short description of the code. Automatically displayed.
Number of Referral Visits	The requested number of visits for this service.
Frequency Period	The period of time within which the number of referral visits are performed. Examples: Every 3 Days
Service Duration Count	The time period of the service. Examples: For 21
Remaining Visits	The remaining number of visits left for the service

Extended Services Provider Fields

Field	Description
Extended Services Provider Summary Up to 10 occurrences of extended provider data can be entered.
Medicaid ID	First supplemental provider ID of requesting provider.
Other Provider ID	Unique identifier used for a provider of health care services. Format: Up to 15 alphanumeric characters.
To quickly search for a provider, click . When found and selected, the provider ID fields are automatically populated.
Other Provider ID Type	The type of provider identifier being used for the authorization. Example: Medicaid, NPI (National Provider ID)
Taxonomy Code	The 10-digit/alpha taxonomy code of the provider. CMS defines the Taxonomy Codes as an administrative code set for identifying the provider type and the area of specialization for all health care providers. The code set is used in X12-278 Referral Certification and Authorization and the X12 837 Claim transactions. It is maintained by the National Uniform Claim Committee (NUCC).
Entity Code	Code identifying an organization entity, a physical location, property, or an individual. Examples: 71-AttendPhys (Attending Physician), 77-SvcLoc (Service Location), SJ-SvcPrv (Service Provider)
Provider Name	The full name of the extended services provider.
Provider Code	Unique code indicating the type of extended services provider. Automatically displayed after the referral is saved.
Used	If checked in the table, the extended services provider was the servicing provider. This field is automatically populated during claims adjudication.
Additional Extended Services Provider Information Fields These fields are the same as those found in Requesting Provider panel, except that the descriptions are about the extended services provider.
Contact Information Fields These fields are the same as those found in Requesting Provider panel, except that the descriptions are about the extended services provider.
Additional Extended Services Supplemental Provider ID Fields Up to 8 occurrences of additional extended services supplemental provider information can be entered. One of these occurrences may be the Medicaid ID found in the beginning of the Requesting Provider panel.
Supplemental Provider ID	Unique identifier used for a provider of health care services. Format: Up to 15 alphanumeric characters.
Provider ID Type	Unique code that indicates the type of provider ID entered. Examples: DEA, NPI, SSN/EIN
Used	If checked in the table, the referred provider was the servicing provider. This field is automatically populated during claims adjudication.
License State	The state in which the referred provider is licensed.

Diagnosis Fields

Field	Description
You can add up to 12 diagnosis codes that apply to the referral request.
Diagnosis Code	A standard code used to describe the nature of a patient's illness or injury.
To quickly search for a diagnosis code, click . When found and selected, the Diagnosis Code field is automatically populated.
Diagnosis Type	Identifies the specific industry code list used for the diagnosis code Examples: BF-Diagnosis, BJ-Admitting, BK-Principal, PR-PatRsnVst
Diagnosis Date	The date the prognosis or medical decision was made and the diagnosis code determined.

Claim Updates Fields

Field	Description
These fields are view-only.
Date	The claim adjudication date.
TCN	The TCN of the adjudicated claim that is associated with the referral. Links to the Claim Inquiry page, line item detail, of the claim applied to this SA, if you have access.
LI	The line number of the claim that is associated with the referral.

Letters & Responses Fields

Field	Description
To edit, in the Letters & Responses table, click the appropriate row. To create a letter, click Create Letter. To view the letter request, click View Letter Request. To view an image of the letter in the EDMS, click View Letter. Note: The View Letter option is only available if the letter request status is Generated.
Created Date	The date the letter request was created.
Template	The name of the template used to create a letter or response.
Date Sent	The date the response or letter was processed (imaged in EDMS and sent to the print vendor and letter recipients).
Days Due Back	The number of days in which the recipient is expected to respond to the letter. This field is also used to calculate the due date.
Due Date	The date the recipient is expected to respond to the letter. The due date is based on the value in the Days Due Back field.
Date Received	The date requested information was received from the letter recipient.
Notify Via Alert	The user that receives an alert about the letter or response.
Alert Based On	An action that causes the alert to be sent. For example, an alert can be dependent on the due date, created date, or date sent.
Recipient Name	The recipient's name.
Letter Request ID	The identification number of the letter request.
Send Alert # of Days	The number of days before or after an event to send an alert. This field is based on the value in the Alert Based On field. For example, if the alert is based on the created date, an alert sent a number of days before or after the created date.
Status	The current status of the letter. Examples: New, In Review, Approved, Generated, Rejected, Deleted
Supv Appr. Req	Indicates that a supervisor needs to review and approve the letter request. Note: This field is automatically selected on the Letter Generation Request page if the pre-defined template has Supervisor Approval Required selected on the Maintain Templates page.
Explanation	An explanation of why the letter request was created. You can enter up to 255 characters.

Referral Exceptions Fields

Field	Description
The Referral Exceptions panel is always displayed. As you scroll up or down the Referral page, the Exceptions panel moves up or down on the page. To redisplay the Exceptions panel with updated information, click Validate.
Ref ID	A unique identifier assigned to the referral request by ND MMIS.
Header Status	The status of the referral. Examples: Pending, Approved, Denied, Voided
Member ID	A unique ID assigned to a member.
MBR Name	The member's full name.
Referral Type	The type of referral. Examples: CSP, PCCM, Other Referral - Dental
Exceptions Fields Only the Status field can be changed.
LI	The line item number associated with the exception.
Code	The exception code. Exceptions are posted to a referral claim when edits, which are business rules defined by North Dakota to manage processing, evaluate the information and find discrepancies. These may include the absence of required information or the presence of invalid information. The exception code link expands the exception panel to display the exception code details.
Status	The status of the exception. Examples: Suspend, Super Suspend Ignore, Deny, Pay, Reject, etc.
Exception Code Detail Fields These fields are displayed when you click the Code link. To hide these fields, click Close.
Exception Code	The exception code selected from the list of exceptions.
Exc Description	The exception code description.
Resolution Text	The first eight lines of the resolution text
Read complete resolution text	Links to the Service Authorization Exception page in Rules Management, if you have access. Tip: Referrals use the same exception codes as service authorizations.

Version as of 5/16/14.