AI Outbound Referral Agent

FQHC patients need specialty referrals often, but 15–30%+ fall through amid denials, delays, and no-shows. Our AI Agent completes the closed loop on every referral and meets all federal and state PCMH (Patient Centered Medical Home) requirements, automating up to 98% of the work involved — including prior auth requirements for outgoing referrals from PCPs to specialists.

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Problem it solves

  • High referral leakage and lost specialty revenue.

What the agent does

  • Finds the right specialist among provider panels or out-of-network specialist networks.
  • Coordinates patient scheduling and specialist office follow-up.
  • Supports pre-exit follow-up scheduling before discharge or visit completion.

How the referral agent works

One continuous workflow from request to completed, in-network care.

TOC Follow-Up Status

94%

  • Completed — 94%
  • Scheduled — 4%
  • Pending — 2%

  1. Find

    Before anything is sent

    • Pull the referral and clinical documents from the EMR.
    • Match in-network specialists on plan, distance and wait.
    • Call the office and confirm they will take the patient.

  2. Authorize

    eRAF and prior auth

    • Submit the eRAF (referral authorization form) by plan or IPA portal, or by fax.
    • Recheck and answer follow-ups until the auth posts.

  3. Book

    Getting the patient there

    • Fax the referral and records to the accepting office.
    • Call the patient with the doctor’s name and address.
    • Three-way call and schedule the visit on the line.

  4. Close

    Back into the chart

    • Call the office to confirm the visit happened.
    • Request, retrieve and file the consult note.
    • Book the PCP follow-up in your EMR.

Expected outcomes

90%
Reduction in staff manual work
5x
Faster prior auth
200%
Increase in referrals closed

Every incomplete referral is a leakage event. First Outcomes turns referrals into completed VBC.

  1. Specialist Matching
  2. TOC Follow-Up
  3. Faster Closure

See the #1 Referral Agent AI in action

We’ll show you exactly how it plugs into your current referral workflow.

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