Overview
skyReferral is an end-to-end referral lifecycle automation platform that transforms 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, skyReferral uses AI to interpret medical records, extract clinical data, verify insurance eligibility, and move referrals through a configurable multi-stage workflow — all while keeping your team in control with human-in-the-loop approvals and full audit trails.
- From fax to first visit faster — AI models interpret unstructured medical records against complex payor criteria, creating payor-ready documentation with fewer delays and denials.
- High-conversion pipeline — Automated classification, routing, and eligibility checks accelerate intake while giving referring providers full visibility without adding work for your team.
- Operational resilience — Human-in-the-loop approvals, automatic inbox retries, and auditable workflows keep you in control while automation handles the repetitive steps.
How It Works
Documents arrive by fax, email, direct upload (PDF, PNG, JPG, TIFF), or partner API. Images are converted to PDF at ingest so every packet can be classified, split, and reviewed page by page. AI identifies referrals, insurance records, and clinical documents, separates multi-patient packets, and merges duplicates.
AI reads medical documents and extracts structured data including patient demographics, referring provider and practice, diagnoses, insurance information, medications, allergies, lab results, and surgical history. The system checks your EHR for existing records, matches or proposes referring practices, and automatically requests any missing documentation.
Insurance eligibility is verified by identifying the correct payor and plan. Benefit investigations and prior authorization processing are initiated automatically. Clinical criteria — including therapy and medication rules — are evaluated against your organization's guidelines, with your team reviewing and approving before any decision is finalized.
Optional stages such as Patient Responsibility can run in parallel before scheduling. Patients are contacted, appointments are booked with the target provider or facility, and post-visit follow-up keeps both the patient and referring provider informed.
Key Capabilities
Centralized inbox for fax, email, upload, and API submissions. Filter by source, see unprocessed counts in the sidebar, and convert documents into referrals with a single action. Combined packets can be split and reclassified without re-upload. Transient processing failures retry automatically with backoff; staff can mark an item unprocessed to send it through the pipeline again.
Process large referral batches with confidence using bulk ingestion with scheduling, inbox processing, and automated failure handling — ideal for high-volume intake and backlog migration.
Downstream systems submit referral documents (and optional structured metadata) over a documented customer API. Submissions are validated immediately, queued into the same inbox pipeline as fax and upload, and tracked until they complete, need review, or fail.
AI reads unstructured medical records and populates structured referral data — patient demographics, diagnoses and ICD codes, insurance details, medications, allergies, lab results, visit notes, medical and surgical history — replacing hours of manual data entry.
Referring practices are matched to a first-class practice catalog as documents are processed. Ambiguous matches surface candidates for a human pick; new practices are proposed and created when the referral is sent to the EHR, not as duplicate catalog noise. Settings let admins create, edit, verify, and merge practices.
Provider lookup is available at extraction. Name-token search, NPI candidate picking, and name/NPI mismatch checks help staff link the correct referring provider before write-back.
AI-powered matching of patients to optimal providers based on specialty, location, availability, and patient preferences. Prioritize in-network providers to reduce leakage.
Weighted scoring tracks referral readiness in real time across five categories — patient information, clinical details, provider information, documents, and insurance — so your team knows exactly what needs attention.
Connects to your electronic health record system to look up existing patients, create new records, add providers and practices, and write back medications and allergies. Clear, human-readable errors surface when an order cannot be created (including duplicate-order checks). Every created entity is recorded on the referral audit trail.
Identifies the correct payor and plan, runs eligibility checks, and surfaces coverage details including copay, coinsurance, deductible remaining, plan type, and prior authorization requirements. Member ID is required on every insurance card. Unmatched payers are flagged so staff can resolve them before write-back. Benefit investigations run end-to-end from a dedicated request workflow.
AI evaluates referral documentation against your organization's clinical criteria to assess medical necessity, including therapy and medication rules. Highlights whether each requirement is met, partially met, or missing — giving reviewers a clear summary to approve or escalate. Therapy is visible on clinical review and on the work-queue task list.
Automatically reaches out to referring providers to retrieve missing documentation via fax, email, or portal. Separate communication stages for provider and patient outreach keep every stakeholder informed. If a fax fails, staff can correct the number and resend without leaving the referral. Failed sends and comments stay on the referral trail.
Book appointments with target providers and facilities directly from within the referral workflow, ensuring referrals convert to scheduled visits without leaving the platform.
Centralized view of all referrals with filtering by urgency (Routine, Urgent, Stat), workflow stage, patient name, due date, and more. Tokenized search finds referrals by partial names or IDs. Dedicated views for Completed, Archived, Snoozed, and All keep worklists clean.
Pause a referral (and its open tasks) until a chosen date, with a required reason. Snoozed work appears in its own dashboard view and wakes automatically when the date arrives, with a notification to the person who snoozed it. Archived referrals cannot be snoozed.
Maximize in-network referral rates. Track referrals from submission through completion with automated follow-up and complete visibility into referral status and outcomes.
Operational analytics for volume, conversion, backlog, time-to-complete, archive rate, and AI impact (classification, EHR write-back, duplicates, matching). Slice KPIs by location, referring provider, therapy, and payer. Ownership views show who picked up and completed each stage.
Task Management & Workflow
Referrals are automatically organized into work queues by workflow stage. Tasks are created as referrals progress, with priority-based assignment ensuring the most urgent work surfaces first. Therapy is shown as a column so specialty work is easy to scan.
Beyond pending and complete, each stage can carry a client-configured journey status (for example, additional documents requested or benefit investigation in progress). Admins edit the vocabulary in agent settings. Status changes are audited and shown on the workflow stepper.
Every AI-automated action can be reviewed and approved by your team before it takes effect — extracted data, eligibility determinations, clinical review findings. Your staff has full visibility and final say.
Workflow stages can be enabled or disabled to match your referral process, including parallel stages such as Patient Responsibility before scheduling. AI agents can be turned on or off for each stage. Upload your own clinical criteria documents to customize clinical reviews.
Categorized comments on the referral, including an EHR log of write-back activity. Mention teammates to notify them; comments wrap cleanly and stay tied to the referral history.
Each task and referral tracks its full history of actions, status changes, fax attempts, snooze events, and EHR-created entities — maintaining compliance and providing complete accountability across the referral lifecycle.
Practice Management
Referring practices are first-class records, not just free-text on the fax.
- Catalog — Create, edit, verify, and merge practices in Settings. Merges re-point existing referrals and keep aliases so later faxes still match.
- Match at processing — After extraction, skyReferral links the referring practice or proposes a new one when name plus a strong signal (address, phone, or fax) is present.
- Create on send — New practices are written when the referral is sent to the EHR, so the catalog is not filled with unverified duplicates.
- Communication defaults — Store the preferred contact mode (fax, email, or portal) on the practice so outreach uses the right channel.
Partner APIs
Instance admins manage service accounts under Settings → API Access: create credentials, rotate secrets, disable or enable accounts, and open in-app API documentation.
| Surface | What it is for |
|---|---|
| Orders API | Authenticated systems list and retrieve orders (referrals), including insurance, clinical detail, missing items, and source documents. Filter by updated time, status, stage, and practice. |
| Inbound ingestion API | Partners POST documents (up to 10 per submission) with a client reference ID. The order is queued into the inbox; poll status until completed, needs review, failed, or dismissed. |
Authentication uses OAuth2 client credentials scoped to the instance. Secrets are shown once at create or rotate and cannot be retrieved later.
Use Cases
| Use Case | Description |
|---|---|
| High-Volume Referral Intake | Organizations receiving hundreds of faxed or API-submitted referrals daily automate classification, data extraction, and triage — processing referrals in minutes instead of hours |
| Referral Leakage Prevention | Track every referral from document receipt through scheduled appointment, ensuring no referral falls through the cracks |
| Prior Authorization | Automate eligibility checks, benefit investigations, and clinical necessity reviews to reduce authorization delays and denials |
| Multi-Site Coordination | Manage referrals across multiple facilities with configurable workflows, journey statuses, and analytics sliced by location |
| Specialty Referrals | Route patients to appropriate specialists within your network based on specialty, location, availability, and therapy |
| Facility Transfers | Coordinate transfers between facilities efficiently with complete documentation and handoff tracking |
| EHR & Downstream Integration | Service accounts and the Orders / ingestion APIs keep your EHR, RCM, and partner systems in sync without manual re-keying |
Platform Integration
skyReferral is part of Skypoint's composable platform, connecting seamlessly with:
- skyData — Unified data foundation and workflow orchestration
- skyMDM — Master data for accurate patient and provider records
- skyAuth — Prior authorization automation for seamless handoff
- skyCare — Clinical workflow integration for care coordination
Get Started
skyReferral is available as part of the Skypoint platform. Contact your Skypoint representative to configure skyReferral for your organization's referral management operations.