Referrals and Blue Chip

 

HIC Online

HIC Online uses referral date information as follows:

o       ReferralDateFrom: The date from which the referral is valid = Commencement Date (=BCPeReferral.EffectiveDate)

o       ReferralIssueDate: The date the referral was issued = Letter Date (=BCPeReferral.LetterDate)

For HIC Online claims, neither the ReferralDateTo, nor the ReferralDateFrom, value is sent to the HIC.  Only the ReferralIssueDate and the period of the referral are sent.  At the HIC end, the date of service of the initial consultation (ie 104/110) is used to figure out the Referral Expiry date.  

 

Special Cases

o       For HIC Online DVA claims, the ReferralDateTo value sent to the HIC is based upon the Letter Date for a non-standard referral period.  

o       What happens if the patient begins a new course of treatment, but is referred by the same referring dr, and is seeing the same specialist?  See also 6.7.4 in the General Explanatory Notes section of the Medicare Benefits Schedule.  Generally speaking, it’s quite obvious when a new referral is required, as the new course of treatment pertains to a different injury/illness.  However, there is one tricky situation.  See (c) of 6.7.4:

“…[if] the patient was last seen by the specialist or the consultant physician more than 9 months earlier, the attendance following the new referral initiates a new course of treatment…”.  

 

There may also be other circumstances that would lead to a referral being invalid. These relate to the provider number of the referring doctor being invalid, and this could have resulted from a de-registered or deceased doctor etc.

The HIC will be making changes in the future to expand the explanations of the errors surrounding this so that users can best make an informed decision about the situation. In the meantime, should a claim be rejected on the grounds of an invalid referral, we should perhaps advise the customer to also check that the referring doctor is still valid.