Patients with complex chronic conditions require extra assistance from providers, specialists, and pharmacies to receive the care and attention needed to support their health and treatment. The referral process is often lengthy and complicated, but avoiding a few easily-made mistakes can prevent delays and expedite a patient’s journey to receiving treatment. With inevitable back and forth exchanges, and lengthy intake processes, making sure the following steps are taken can avoid unwanted follow-ups and save time.
Include a Diagnosis Code
The critical first step for any specialty pharmacy to advocate and research on behalf of the patient and the prescriber is the diagnosis code. Without the diagnosis code, coverage for the prescribed medication will be denied or delayed. The diagnosis code will also allow a specialty pharmacy to research financial assistance options. Having the diagnosis code can also enable the specialty pharmacy to research financial assistance options available for the patient. There are numerous grants and financial assistance funds available and categorized based on the patient’s diagnosis.
Make Sure the Insurance Card is Clear to Read
Ensuring the image of the patient’s insurance card is clear is one of the easiest steps to avoid wasted time. Having all the information from the front and back of the insurance card will prevent potential phone tag for a pharmacy to try and obtain the critical details. If the image of the insurance card is unclear, provide the missing information separately.
Providing The Patients Details
Equally important as the patient’s insurance information are the patient’s personal facts. Be as thorough as possible when providing demographics like age, gender, ethnicity, employment status, etc. Pharmacies could potentially have a difficult time connecting with the patient to receive the personal details needed to get the approval process started. A patient’s details will allow a pharmacy to do a proper investigation of benefits, and without them, a pharmacy will not get very far into the process.
In order for a referral to be legal and valid, a prescriber’s signature must be included. Without the prescriber’s signature, prior authorization will not be given to the referral and the process of approval will be stalled. Making sure the referral has a signature is one of the easiest steps to take to prevent a setback or delay.
Some medications do not require prior authorization but for those that do, make sure the patient’s recent medical records are included with the referral form. This will allow specialty pharmacies to submit any qualifying questions a payer may have to get a medication approved.
At PFSP, our Custom Referral Forms make submitting a referral form a breeze!
PFSP Specialty Pharmacy provides custom referral forms for physicians and providers, which help avoid unnecessary delays or setbacks.
PFSP Specialty Pharmacy provides patients and their physicians an exceptionally high standard of care with our growing team of specialized pharmacists and staff. Our dedicated team of pharmacists focus on improving adherence for patients and work to find an approach that works best for them. Bringing a fresh take on what a Specialty Pharmacy can and should be, we are committed to the care of our patients. We take pride in being an ethical resource within our community and strive each day to help our patients live enriching and full lives.