A medical service is either referred or not referred. If it is referred, you should enter a referral date and provider number in the surgeon section on the Operation page. If it is not referred, you should leave the referral date blank, and the surgeon and provider number are optional.

 

A referral is required for 'referred consultations' such as 17640-17680.

A referral is not required for standard anaesthetic procedures.

 

Diagnostic imaging and pathology items require a referral. Such referrals are called 'Requests'. If your referral date and provider number relate to a diagnostic imaging or pathology item, you should tick the 'Request' box next to the referral date.

 

The need for a diagnostic imaging service may be decided by the anaesthetist in the absence of a specific referral. In this case, the service is said to be 'self-determined'. Diagnostic imaging items performed in the course of an anaesthetic are normally self-determined. For Eclipse claims, the SD flag should be added to the service text for such items.

 

For Eclipse claims, a service is either referred or not referred. If it is not referred, individual items that would normally require a referral can be self-determined. In addition, a claim that would normally require a referral can be sent with a 'referral override'. This is a flag that defines why the referral was not obtained. It is set on the first page of the Eclipse claim creation dialog box.

 

A referral date, referral override and self-determined flag are mutually exclusive. If one is set on an account, the others cannot be set.