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Referral Management in Health Cloud
Referral Management in Agentforce Health centralizes the referral lifecycle to reduce administrative burden and prevent patient leakage. By connecting providers, coordinators, and patients on one intelligent platform, it replaces fragmented, manual workflows with a single source of truth: the Clinical Service Request (CSR).
Required Editions
Available in: Lightning Experience Available in: Enterprise and Unlimited Editions with Health Cloud |
The Intelligent Referral Journey
Use AI and automation to manage the full referral lifecycle across three main stages:
- Referral generation and intake
- AI-powered document processing transforms unstructured faxes into structured CSR records.
- Built-in referral templates automatically generate all necessary records so coordinators can begin work without manual data entry.
- The system establishes the CSR as the single source of truth for every referral to ensure data consistency.
- Referral tracking and triaging
- Predictive intelligence assigns scores to incoming referrals, helping coordinators focus on high-need cases that need manual review first. Referral scores aren’t quality scores. They’re based on time in the queue and listed clinical urgency, not ingested clinical data. Don’t use predictive scoring to triage emergency cases.
- The system automatically triggers eligibility and benefits verification when insurance data is present.
- Automation rules determine the processing stage of each referral based on verification results.
- The platform automatically creates cases to unlock advanced capabilities like service-level agreement tracking and queue management.
- Referral coordination
- Marketing 360 delivers intelligent, Omni-Channel outreach via SMS and email at key milestones.
- When a CSR is created, the system sends immediate acknowledgments to both the referring provider and the patient.
- Automated follow-ups request missing information from providers, with a reminder sent if they don’t respond within three days.
- Multi-touch outreach prompts patients to schedule appointments after a referral is accepted, with a follow-up email sent after three days if no booking occurs.
- The system closes the loop by automatically updating the CSR status to Scheduled or Completed based on appointment activity, providing real-time visibility to all parties.
Who Uses Referral Management
Referral Management connects key stakeholders on a single, intelligent platform to support communication and coordinated care throughout the referral lifecycle.
| User Role | Key Responsibilities |
|---|---|
| Referring Provider | Creates and submits patient referrals to specialists within or outside the network. They receive automated acknowledgments and real time status updates at every key milestone of the referral process. |
| Referral Intake Coordinator | Manages incoming referrals by using an intelligent, prioritized worklist to triage referrals, follow up on missing information, and ensure referral acceptance. AI scoring and automation significantly reduces the need for manual research and repetitive outreach. |
| Patient | Receives timely, automated notifications regarding referral status and scheduling through their preferred communication channels. This transparency reduces uncertainty and eliminates the need for the patient to call back for manual updates. |
- Basic Clinical Service Request Setup
To support common management tasks for clinical service requests (also known as referrals), configure the clinical service request page layout, configure flows, and set up paths and actionable lists. - Configure the Create Referral Flow
Use Flow Builder to automate your referral creation process. With the Create Referral Flow, your users provide relevant patient, provider, and facility details, and the flow creates related referral records for them. Add the Create Referral flow to the patient account record page and the Clinical Service Request detail page. The flow is also available as a quick action for provider search results. - Create Referrals from Inbound Documents
Transform documents received by email and fax into clinical service requests. You can automate referral creation by designing a workflow that uses Intelligent Document Automation features and the Process Received Document invocable action. - Configure the Clinical Service Request Page for Referral Coordinators
Schedule appointments, complete assessments, add care plans, enroll patients in care programs, and launch actions directly on a clinical service request. - Set Up the Referral Management App
Give referral coordinators complete visibility into key referral metrics by setting up the Referral Management app and Enhanced Analytics for Healthcare. The Referral Management app shows Referral Analytics dashboards such as Referrals Insights, Top Referrals, and Referrals Performance. These dashboards help coordinators assess the referral process efficiency and expedite patient care. - Automate Referrals
Create referrals by using a guided flow that gathers data and creates related records for you. Accept referrals directly from a clinical service request. - Provide a Secure Referral Form to Guest Users
Reduce incoming fax volume and delays in patient care by digitizing your referral process with an online experience for guest users. Get a guest referral website up and running quickly by customizing a prebuilt sample that guides users through creating a referral and uploading related documents.
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