Announcing e-referral enhancements beginning Dec. 7, 2015
We are working to make our new electronic referral system more user-friendly. As more provider offices sign-up and log in to use Blue Care Network's e-referral, we're discovering ways to make the system more responsive to providers' needs. Two major enhancements are available beginning Dec. 7, 2015.
Searching for patient eligibility
E-referral users will no longer need to click through a list of view links to locate a member's active coverage span. E-referral will bring up the member's active coverage for today's date. This will allow the provider to see only links to active coverage and will reduce the need to click on multiple view links to locate the active coverage. It will also reduce the number of instances where a referral is submitted under an inactive coverage span, which may cause the request to pend until BCN Care Management can research the issue. The provider also has the option to search for older coverage by entering a specific effective date in the date field.
Searching for a case
When searching for a referral already submitted for a patient, a provider will now have the option to search for specific associated providers or all associated providers. E-referral previously allowed the user the options to search by the provider that was in focus or all associated providers. This enhancement brings up a customized list of referrals based on the user's needs and avoids returning unrequested results. The user can also search by Provider ID or Patient ID and a specific date.
With any new system, it takes time to make it run as efficiently as possible. With this phase of e-referral enhancements, BCN's goal is to help providers choose the most appropriate eligibility information for the date of service and reduce the amount of waiting time for a response from us. We will continue to make improvements as we work with you, our partners in care.
Summary of December 2015 Enhancements
| Enhancement | Viewing eligibility | Case search |
|---|---|---|
| Previous implementation | System brings up all eligibility spans, both active and inactive. Users must search through a list of views to locate the active coverage. | When searching for a referral already submitted, users could search cases based on the provider in focus or all associate providers. |
| Issue | Challenge to submit a request for members who show multiple incidents of eligibility. Referral is delayed if user chooses an inactive coverage from the list. BCN staff must void and re-enter the case, causing a delay | System returned only a limited list of cases based on the provider in focus or a list of cases based on all associate providers. |
| December 2015 enhancements | System will show only active eligibility and will default to today's date. Only active coverage will display vs. active and inactive spans. Users have the option to change the effective date if they are searching for a different date. | User can now choose specific providers among the list of associate providers, in addition to the provider in focus, or they can choose "all." |
| Advantage | Users will only see results based on the "eligibility-as-of" date entered in the patient search instead of a list of active and inactive eligibility spans. The enhancement will help users select a member with active coverage and reduce waiting time for a response. | Customizes the number of results returned based on user selections. Can also search by Provider ID, Patient ID, and date |