Overview
skyReferral automates the referral lifecycle, turning unstructured medical documents into payor-ready referrals faster, with fewer denials, and without adding work for your team.
Built on the HITRUST r2 certified Skypoint platform, it uses AI to interpret records, extract clinical data, verify eligibility, and move referrals through a configurable workflow, with human-in-the-loop approvals and full audit trails.
- From fax to first visit faster — AI checks records against payor criteria to produce payor-ready documentation.
- High-conversion pipeline — Automated classification, routing, and eligibility checks speed intake.
- Operational resilience — Approvals, automatic retries, and auditable workflows keep you in control.
How It Works
Documents arrive by fax, email, upload (PDF, PNG, JPG, TIFF), or partner API; images are converted to PDF. AI identifies document types, splits multi-patient packets, and merges duplicates.
AI extracts demographics, referring provider and practice, diagnoses, insurance, medications, allergies, labs, and surgical history, checks your EHR for existing records, and requests missing documents.
Eligibility and benefits are verified, benefit investigations and prior authorizations start automatically, and clinical criteria, including therapy and medication rules, are evaluated for your team to approve.
Optional stages such as Patient Responsibility can run in parallel before scheduling. Appointments are booked and follow-up keeps patients and referring providers informed.
Key Capabilities
One inbox for fax, email, upload, and API submissions. Split and reclassify packets without re-upload; transient failures retry automatically, and items can be reprocessed.
Scheduled bulk ingestion with automated failure handling for high-volume intake and backlog migration.
Partners submit documents and optional metadata over an API; submissions are validated, queued into the inbox, and tracked to completion.
AI populates structured referral data, including ICD codes, insurance, medications, labs, visit notes, and history, replacing manual entry.
Referring practices are matched to a practice catalog during processing, with candidates surfaced for ambiguous matches and new practices created on EHR send.
Name search, NPI candidates, and mismatch checks help link the correct referring provider before write-back.
AI matches patients to providers by specialty, location, availability, and preference, prioritizing in-network providers.
Weighted scoring across patient, clinical, provider, document, and insurance categories shows what still needs attention.
Look up and create patients, providers, and practices, and write back medications and allergies. Clear errors explain failed orders, filed order numbers are captured, and created entities are audited.
Identifies payor and plan, runs eligibility checks, and surfaces copay, deductible, and prior authorization needs. Unmatched payers are flagged, and benefit investigations run end to end.
Verify benefits for one payer or every payer on a referral in one step, with tier-aware cost share, deductibles, out-of-pocket accumulators, and cost by service type and therapy. Coordinators can enter benefit values by hand or mark a payer verified manually, and hand-entered values are kept on re-verify.
Generate a consolidated or per-payer benefit verification document and a copay assistance document, versioned by drug and date. Call-sheet details stay on the referral, and the finished document can be sent to the EMR.
AI assesses medical necessity against your criteria, showing whether each requirement is met, partially met, or missing. Each therapy's required clinicals are set under Rules, and the checklist ticks off items found in extracted data.
Request missing documents from providers by fax, email, or portal, with separate provider and patient outreach. Failed faxes can be corrected and resent in place.
Send a fax from the patient chart using administrator-managed cover-letter templates and sender locations. The Outbox tracks every outbound fax with preview, resend, and in-app and email alerts when a fax or its EHR upload fails.
Upload classified documents from the patient chart and attach documents to tasks. The patient's document list includes delivered outbound faxes.
Book appointments with target providers and facilities from within the referral.
Filter referrals by urgency, stage, patient, due date, and more, with partial-match search and views for Completed, Archived, Snoozed, and All.
Pause a referral or individual task until a date, with a reason. Snoozed work wakes automatically with a notification, and reschedules are recorded.
Maximize in-network rates with end-to-end tracking and automated follow-up.
Track volume, conversion, backlog, time-to-complete, and AI impact, sliced by location, provider, therapy, and payer, with stage ownership views.
Task Management & Workflow
Tasks route to queues by the task type chosen at creation, with priority-based assignment. Filter by lifecycle status and add a Due Date column; Therapy is a default column.
Admins configure queues, task types, custom statuses, task drawer fields, and queue list columns, filters, and sorting from Agent Config, without a release.
Each stage can carry client-configured statuses such as "benefit investigation in progress." Deleting one moves its open tasks to In Progress, and changes are audited.
Your team reviews and approves extracted data, eligibility, and clinical findings before they take effect.
Enable or disable stages, including parallel ones, toggle AI agents per stage, and upload your own clinical criteria.
Categorized comments, including an EHR write-back log, with mentions that notify teammates.
Every task and referral records actions, status changes, fax attempts, snoozes, and EHR-created entities.
Admins manage cover-letter templates, each with an optional default recipient, and sender locations, which default to the patient's home location.
Practice Management
Referring practices are first-class records, not free text.
- Catalog — Create, edit, verify, and merge practices; merges keep aliases so future faxes still match.
- Match at processing — Link or propose a practice when a name plus address, phone, or fax is present.
- Create on send — New practices are written on EHR send, avoiding unverified duplicates.
- Communication defaults — Store each practice's preferred contact channel.
Partner APIs
Instance admins manage service accounts under Settings → API Access: create, rotate, disable, and view API docs.
| Surface | What it is for |
|---|---|
| Orders API | List and retrieve orders with insurance, clinical detail, missing items, and documents, filtered by time, status, stage, and practice. |
| Inbound ingestion API | Submit documents with a client reference ID, then poll status until done. |
Authentication uses instance-scoped OAuth2 client credentials; secrets are shown only once.
Use Cases
| Use Case | Description |
|---|---|
| High-Volume Referral Intake | Automate classification, extraction, and triage in minutes |
| Referral Leakage Prevention | Track every referral through to the appointment |
| Prior Authorization | Automate eligibility, benefits, and necessity reviews |
| Benefit Verification | Verify and document benefits for every payer without calling payers |
| Multi-Site Coordination | Configurable workflows and analytics by location |
| Specialty Referrals | Route to in-network specialists |
| Facility Transfers | Documented, tracked handoffs |
| EHR & Downstream Integration | Sync EHR, RCM, and partners via APIs |
Platform Integration
skyReferral connects with the rest of Skypoint's composable platform:
- skyData — Unified data and workflow orchestration
- skyMDM — Accurate patient and provider master data
- skyAuth — Prior authorization handoff
- skyCare — Care coordination workflows
Get Started
skyReferral is available on the Skypoint platform. Contact your Skypoint representative to get started.