Claims

The system username or user identifier of the individual who last updated a referral record, captured in referral management and utilization review systems to maintain an audit trail of changes made to authorization details, status, or patient information.

Timestamp recording the most recent update to a referral authorization record, such as status changes, quantity adjustments, or provider substitutions. Critical for EHR and managed care systems to maintain audit trails and synchronize downstream claims adjudication data.

The timestamp recording when a referral record was last updated in the system, used in referral management and utilization review workflows to audit changes, track authorization amendments, and support data reconciliation across connected health information platforms.

Human-readable label assigned to a referral record, typically describing the specialty type or clinical purpose of the authorization. Used in EHR and care management systems to support provider communication, member portals, and utilization reporting for data engineering pipelines.

Business-facing alphanumeric identifier for a referral authorization, distinct from internal system keys, used for operational communication between providers, health plans, and members. Referenced in claims submission, EOB documents, and managed care authorization tracking systems.

The date on which the patient's symptoms or condition requiring specialist care first began, recorded on the referral to establish clinical context, support medical necessity review, and align with diagnosis coding for referral authorization and claims adjudication.

The patient's blood oxygen saturation level recorded at the time of referral, used as a clinical vital sign to document the patient's respiratory status, support medical necessity determinations for specialist referrals, and inform the receiving provider's care planning.

The actual dollar amount paid by the health plan or payer for services rendered under a referral authorization, recorded in claims and referral management systems to track expenditures against authorized amounts and reconcile specialist reimbursements.

The date on which payment was issued by the health plan or payer for services rendered under a referral authorization, used in claims and referral management systems to track payment timelines, monitor prompt pay compliance, and reconcile provider remittances.

Foreign key or reference linking a referral record to its originating parent referral, enabling hierarchical tracking of sub-referrals or re-referrals. Used in managed care and EHR systems to model referral chains for utilization management, analytics, and authorization genealogy reporting.

The total dollar value of a payment transaction processed for services delivered under a referral authorization, used in claims adjudication and referral management systems to reconcile reimbursements, track specialist payments, and support financial reporting.

The current processing state of a payment associated with a referral authorization, such as pending, paid, or denied, used in claims and referral management systems to monitor reimbursement progress, identify delays, and support provider payment dispute resolution.

Numeric percentage value associated with a specialist referral authorization in EHR and managed care systems, often representing cost-share, approval rate, or utilization benchmarks used in referral analytics and provider performance reporting.

The authorized time span during which a specialist service referral remains valid in EHR, managed care, and claims systems. Defines start and end boundaries for approved specialist visits, used to validate claims and prevent out-of-period service denials.

The telephone contact number associated with a specialist referral request in EHR and care coordination systems. Used to facilitate communication between referring providers, specialists, and patients during the referral authorization and scheduling workflow.

The name by which the patient prefers to be addressed, recorded on the referral to support respectful patient communication during specialist scheduling, care coordination outreach, and clinical interactions associated with the referred episode of care.

The agreed-upon or estimated cost of specialist services authorized under a referral, used in referral management and financial systems to project care expenditures, support contract rate validation, and facilitate cost comparison across network providers.

Flag identifying whether a referral authorization is the primary referral on record for a patient's episode of care. Used in managed care and utilization management systems to distinguish the principal referral from secondary or supplemental referrals when multiple authorizations exist.

The urgency or importance ranking assigned to a specialist referral request in EHR and care management systems, such as routine, urgent, or emergent. Drives triage workflows, scheduling timelines, and authorization queue processing in managed care platforms.

Patient's heart rate in beats per minute recorded at the time of referral initiation. Captured in clinical referral documentation to provide the receiving specialist with baseline vital sign data, supporting continuity of care and triage prioritization for the referred encounter.