Referral request - data classification

• Patient information– Patient demographics, covered by MU2 and CCDA

requirements– Patient identifier (Med Rec Number)

• As known to the sender• Common for both sender and receiver• As known to the receiver

– Two elements from spreadsheed don’t belong• SSN should not be used for healthcare• Medicare # - this is administrative information, belongs to

insurance information

Referral request - data classification

• Referral administrative information– Referral Identifier (not present in the spreadsheet)– Referral Date– Referral Approval obtained– Insurance information (multiple insurance policies/kinds

possible) – usually covered in ADT or X12 messages• Kind (primary, secondary, Medicare/Medicaid, Worker’s comp)• Policy number• Group number• Insurance member ID (e.g. Medicare #)• Guarantor/Subscriber/Insured demographics

Referral request - data classification

• Referring provider (sender) information• Receiving provider information• Patient’s PCP (if different from sender and

receiver)– Information provided by provider directories• Provider identifier

– Direct address– NPI #

• Provider demographics• Provider organization

Referral request - data classification

• Clinical information– Reason for referral– MU2 specified clinical information• Problems• Medications• Allergies• Relevant lab results

– Additional clinical information (depending on specialty)