Referring Provider Setup

After setting up the providers in your provider list, you will need to set up your Referring Provider list. The Referring Provider list contains a list of doctors who refer patients to you. When dealing with HMOs, and in some other circumstances, Referring Providers are required for specialists.

Generally, the Referring Provider list will not contain doctors who are in the same practice as the providers entered into the Provider List. The exception to this is if a supervising provider is required for the claim. This usually occurs when billing claims where the provider is not a doctor, but a Nurse Practitioner or PA under the supervision of a provider in the office. Medisoft v12 and earlier pulls Supervising Provider information from the Referring Provider List. Because of this, you may need to enter some doctors as both Providers and Referring Providers. Since v14 Supervising Provider can be pulled from either the Referring Provider List or from the Provider List.

The referring provider list is accessed by clicking the Lists menu and Referring Providers.

 

 

Within the Referring Provider screens, you will see many of the same fields that exist on the Provider screen. We will focus on the fields that are different or that have unique functionality.

Specialty: If you are sending electronic claims, select the referring provider’s special field of practice from the Specialty list. If you need to use a specialty code that is different than the usual code, select “Not Listed” and enter your specialty code in the data entry box that appears next to the Specialty list.

Referring Provider IDs Tab: The IDs tab available for Referring Providers mirrors the functionality of the grids for Providers. You will need to create a record in the grid for each referring provider. In this record, you can link the referring provider to a particular insurance carrier/class, if needed, and include other billing details such as the referring provider’s NPI, taxonomy, and other legacy IDs.

 

 

 

TIP: If upgrading from a previous version, you may have numerous multiple legacy Referring Provider ID entries that no longer apply and only a few rows that need to be set up. You may save time by deleting all entries and setting up the few rows you need. Press CTRL + DELETE to delete all ID entries in the Practice, Provider, Referring Provider, or Facilities IDs grids. Use this with caution since all your entries will be removed.

 

Once you have entered all applicable information for a Referring Provider, click Save.

Tips and Tricks:
Many Primary Care Providers and some specialty practices that do not participate in HMOs may not have the need to enter or track referrals and referring providers.
When an office first begins their data entry, they may not know which providers to enter into the referring provider list. This list will grow as patients are seen and bring their referrals with them.

 

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