Kalix's Referrals contain important client information including the referral reason, the referral source, diagnosis, and appointment tracking This information is used by the billing feature to produce CMS 1500 forms and superbills.
Referrals can also be used to keep track of the number of appointments a client has attended via the referral tracking functionality and link the referral source to the client.
Note: If you create superbills or CMS-1500 forms, even if the client does not have a referring provider, we still recommend that you create a referral for them. A referral does not require a referral source. Referrals are very useful for auto-adding the diagnosis reasons (ICD-10 diagnosis) to superbills and CMS -1500 forms.
Contents of this article:
Creating a New Referral
Hover your cursor on the Clients tab and choose Referrals & Diagnosis.
There are 2 different navigation pathways to create a new referral.
Pathway 1
To create a new referral, on the Referrals page, click on the Plus button located at the top of the screen (shown below).
Pathway 2
On the client's Cover Page, under the referrals subsection, click on the New icon as shown below.
Alternatively, you can use the New Referral button on the left panel of the client's file.
New Referral Page
All pathways lead to the New Referral page (shown below). We will now go over the different parts of this page.
Referral Page Sections
Date
There are two date fields, date received and date on referral.
Date - The actual date you created the referral.
Date on Referral- The date written on the referring practitioner's referral form (if applicable).
Status
There is also the status of the referral.
Assigning a status against referrals can assist with the management and organization of client flow. There are four referral statuses:
Waiting List- Assign this status to a referral if you are yet to contact the applicable client to arrange an appointment. Referrals on the waiting list are managed under the subsection of Waiting List (Client tab -> subsection Waiting List). When you book an appointment associated with a particular referral, the referral status will automatically change to active.
Active- Assign this status if you are providing the applicable client with ongoing care under the referral.
On Hold- The referral is still valid (i.e. has appointments/hours remaining and not expired), but the client is not receiving ongoing appointments under it e.g. because they are on holiday.
Closed- The referral is no longer valid or client has ceased attending appointments.
To select a referral status, just click on the Status field and the drop-down menu should appear, click on your selection.
Client
To link a client click on the link icon to search for the client.
A list should be generated containing clients with similar names, just click on the applicable name to select it.
If your client is yet to be saved into Kalix, click on the link Clients tab and create a new one. You will be redirected to the New Client screen, enter your client's details and save. Once you have created and saved the client, go back to the New Referral screen.
ICD-10 Diagnosis Codes
When creating bills (superbills and CMS 1500) in Kalix, data entered into this section will automatically be input into your bill.
Kalix offers you the ability to enter several ICD-10s. All of the ICD-9 and ICD-10 diagnosis codes are pre-loaded into Kalix. To add a diagnosis click on the pencil and the diagnosis box will appear.
Qualifier (Optional)
First symptom: enter the date of the first onset of the present illness, injury, or pregnancy. For pregnancy, use the date of the last menstrual period (LMP) as the first date. This field corresponds to item number 14 on the CMS 1500 form.
Referring Provider
To add your referral source e.g. the referring provider, click on the link icon.
Start writing their name in the Contact field. A list should be generated containing contacts with similar names, just click on the applicable name to select it. For more information about contacts, click here.
Note: The Contact must be created before going to the Referral & Diagnosis Tab.
The referral source will be entered into Superbills and CMS 1500 forms generated in Kalix as the Referring Provider (CMS 1500 form field 17).
Once you have linked the referral source, if billing using the CMS 1500 form, you can select whether the referral source is a referring, ordering, or supervising provider.
To save time Kalix will automatically select referring provider for you.
Appointment Tracking
Kalix allows you to place an appointment cap and expiry date against referrals. Click here for details.
Miscellaneous Section
These are miscellaneous client details that are occasionally required for insurance billing purposes. If the referral is linked to an insurance bill, Kalix will automatically complete the corresponding fields on the CMS 1500 form.
Other Date Qualifier
Condition is related to Employment, Auto Accident, Other Accident: select the relevant tick boxes if the client’s illness or injury is related to employment, auto accident, or other accident.
“Employment (current or previous)” indicates that the condition is related to the client’s job or workplace.
“Auto accident” indicates that the condition is the result of a vehicle incident.
“Other accident” indicates that the condition is the result of any other type of accident.
These fields correspond to item numbers 10a–10c on the CMS 1500 form. When creating a CMS 1500 form in Kalix, if these fields are not selected Kalix, will automatically enter "no" in these fields for you.
Dates unable to work in current occupation:
If the client is employed and is unable to work in their current occupation, enter the date range they are unable to work. An entry in this field may indicate employment-related insurance coverage. These fields correspond to item number 16 on CMS 1500 form.
Additional Notes
Free text for any additional information.
Referral Summary Page
The referrals summary page lists all of your saved referrals. You can search for, sort, and order referrals on this screen.
Search- You can search for referrals using keywords in the Search field.
Filter-To view referrals saved between a specified period of time, click on the Filter field as shown below and select the period you would like to see.
Date range- You are able to view referrals made between a specified date range in the next two fields. Select the starting date in the second field and the end date in the third field.
Status- In the last field you can choose to view referrals that are assigned a particular status (Waiting List, Active, On Hold, Closed).
Sort- The table can also be sorted by each column; date, client ID, name, date of birth, referral reason, referral source, and status.