STIHC Referral Policies  ​

Definitions
STIHC Provider – the STIHC medical provider generating the referral
Referred Patient – the person that is being referred
Referral Provider – the provider/organization/service that the patient is being referred to
Referral Specialist – the STIHC referral employee (job title)
 
I. Referral Priority Timelines
 
Priority 1: Emergency Referral, should occur within 24-48 hours (STIHC Provider will likely need to have Provider-Provider conversation)
Priority 2: Should occur within 14 days
Priority 3: Should occur within 60 days
 
II. STIHC Provider Responsibilities
 
The need for a referral can only be determined by a STIHC medical provider (the “STIHC Provider”). 
 
The STIHC Provider is responsible for the following:
  1. Informing the Referred Patient of the referral.
  2. Having and documenting a discussion with the Referred Patient about why the referral is necessary and the risks of not following through with the referral.
  3. Providing the Referred Patient with a copy of the referral, STIHC referral policies, and what to expect next in the referral process.
  4. Documenting the need for the referral in the Referred Patient’s electronic medical record.
  5. Ensuring the referral is entered into the Referred Patient’s electronic medical record.
  6. (After the referral) Reviewing the notes from the Referral Provider and documenting the treatment recommendations in the Referred Patient’s electronic medical record.
  7. (After the referral) Following up with the patient after the referred visit to incorporate findings from the visit into the patient’s treatment plan.
  8. (If leaving their position at STIHC) Transferring the care of all patient cases with open referrals to a designated provider prior to leaving STIHC and informing the patient of that transfer.
 
III. Referred Patient Responsibilities
 
The Referred Patient is responsible for the following:
                                                                
  1. Asking questions to appropriate STIHC staff (the STIHC Provider or Referral Specialist) or the Referral Provider staff if something is not understood.
  2. Ensuring STIHC has a reliable method of contact on file (can be phone (must have voicemail set-up), mailing address or request for home visit with a designated date/time).
  3. Following instructions from the Referral Specialist to make appointments.
  4. Making and keeping all appointments with the Referral Provider, or notifying the Referral Provider of the need to change or cancel an appointment(s) according to the Referral Provider’s requirements for notice (e.g. 24 hours, etc).
  5. Requesting STIHC Transport Services assistance with transportation to the Referral Provider through STIHC, if needed, with 48 hours advance notice (unless it is an urgent/emergency visit happening to soon).
  6. Understanding their health insurance plan financial options/obligations for covering the cost of the referral.
  7. Paying any No Show or Late Cancellation fees associated with the referral appointments.
  8. Notifying the Referral Specialist in writing if they decide to decline the referral.
 
IV. Referral Specialist Responsibilities
 
Once a referral has been entered into the Referred Patient’s electronic medical record at STIHC, the STIHC Referral Specialist is responsible for the following:
  1. Identifying the appropriate Referral Provider (if not already identified in the referral).
  2. Sending the referral to the Referral Provider.
  3. Contacting the Referred Patient (according to their identified preferred reliable method of contact) with an update on the referral status and instructions for making an appointment.
  4. Documenting referral status updates in the appropriate section of the Referred Patient’s electronic medical record.
  5. Review case with STIHC Provider and Purchased/Referred Care (if applicable) if encountering obstacles to referral happening within the designated referral priority timeline.
  6. (After referral) Request documentation of the referral from the Referral Provider.
  7. (After referral) Close referral after confirming with the STIHC Provider (or delegated nursing staff) that referral is complete *or* after criteria for closing an incomplete referral have been met according to Section V of these policies.
 

V. Closing Referrals
 
A referral will be closed by the Referral Specialist as either “Complete” or “Incomplete”.
 
When all of the following criteria are met, a referral will be closed as “Complete”
  1. The Referred Patient received the referral service.
  2. Documentation from the Referral Provider has been received and reviewed by the STIHC Provider.
  3. Documentation of the STIHC Provider’s review of the referral service is in the Referred Patient’s electronic medical record.
 
Alternatively, if one of the following criteria are met, the referral will be closed as “Incomplete”:
  1. The Referred Patient is not responsive to 3 documented attempts to contact them utilizing the contact information STIHC has on file for the Referred Patient and the Referral Provider has reported not being able to contact the patient.
  2. The Referred Patient no-shows to the scheduled appointment with the Referral Provider.
  3. The Referred Patient informs the STIHC Provider or the Referral Specialist in writing that they decline the referral against medical advice.
  4. The Referred Patient does not follow-through with their responsibilities according to Section III of these policies.
 
If a referral is closed, whether it is closed as Complete or Incomplete, it cannot be reopened. A new referral may be opened if a STIHC Provider determines it is medically necessary for the patient. 

These Referral Policies are enacted by MTC Resolution 56-19. 
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