In alignment with the NHSEs new referrals (pathways), the ability to create referrals via an appeal has been developed to promote better data quality. There are two ways this can be done. Through auto-creation or through manually linking.
Auto-creation of a referral
When you have created and saved a appeal which has the correct configuration, and then revisit it, it will automatically configure the referral which has been mapped against that specific appeal.
Referral form cancelled in error
A cancelled referral form cannot be reinstated and a new form will need to be created.
View the appeal eligibility outcomes
If you have Client Administrator access, follow these simple steps to see the appeal eligibility outcomes:
Click Admin and then My Company.
Click CMS Configuration.
Within the Appeals section, click on Appeal Types.
Under the Generate New Patient Referral Type column, you can see if there are any outcome types that has been populated for the patient case type.
Click into a Patient Case Type.
You can see the Generate New Patient Referral Type drop down.
📌Note: Make sure 'Generate New Patient Referral Type' is populated otherwise upon completion of the appeal, a referral will not be generated.
Create a new appeal
If you have Client Administrator access and have the correct permissions, follow these simple steps to create a new appeal:
Click the CMS tab.
Click on Referrals.
Look for a referral which has a Referral Status of 'Eligible' or 'Not Eligible', as the referral needs to have had a decision made on it.
Click into the referral.
Click the Actions button and click New Appeal.
Fill in the mandatory details.
Make sure the Appeal Type dropdown matches the appeal type mapped in 'Generate New Patient Referral Type'
Click Save.
You will be taken to the page to the start of a new internal referral wizard with the new referral type pre-selected and locked. Here you will need to fill out all the mandatory information and submit the referral form.
The appeal will then be visible on both the original referral and the new referral. There will be two panes showing the source appeal and then the subsequent referrals if they exist, which is to make it clear as to which referral is the latest and which appeal it originated from.
Manual linking of a referral
There has been new development of manual-linking functionality, allowing you to create a referral via an appeal.
When a referral has been created in the past with an appeal type that has been mapped to generate a referral, but a referral had not been created, then on the Patient Appeal Details page you now have the option to either create 'New Subsequent Referral' or 'Link to Existing Subsequent Referral'.
To be able to see these manual-linking functionalities, make sure your appeal is in the completed status and then follow these simple steps:
Go to the patient number.
Click on Appeals and click on the specific appeal.
Click Actions, to see the two linking options.
If you select New Subsequent Referral you will be taken to the referral creation wizard to create the referral which has been mapped against the appeal type.
If you select Link to Existing Subsequent Referral, you can link the appeal to an existing referral that has not already been linked to an appeal as a subsequent referral.
