If you need to refer a patient to an out-of-province specialist, you must send a request to Health PEI (HPEI) by creating and submitting a no-charge referral claim. The request is reviewed by HPEI and you and the patient receive a letter indicating whether the request is approved or denied.
When creating a claim, you must add the name and billing number of the provider you are referring the patient to.
Steps
1. Depending on your workflow, create an insured bill from an encounter, from the Visits dashboard or from the patient's chart.
2. Add one of the service codes 9401 to 9412. See Adding and modifying billing items (service codes) to your provincial bills for more details.
3. Under Diagnosis Codes for each billing item, search for and select the diagnosis you're referring the patient for.
4. Under Facility type, select Provider Any Facility Type.
5. Under Facility, select one and if not listed, select the province.
6. Select the Referred To checkbox.
📌 Note: If you entered the service code 9401, the checkbox is selected automatically.
7. Under Referred To, search for the billing number 999 and select Out of Province Physician.
8. Select Show Advanced Fields and then Edit Comment. Type in the yellow Comment text box that appears, e.g. where the patient is referred to and the reason. Click Update.
9. Click Save.
📌 Note: If you did not add the Referred To details, you cannot save the billing item. A validation error message appears.
Updated October 16, 2023