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 and auditable workflows keep you in control while automation handles the repetitive steps.
How It Works
Receive & Classify
Documents arrive by fax, email, or direct upload (PDF, PNG, JPG, TIFF). AI automatically classifies each page — identifying referrals, insurance records, and clinical documents — and routes them to the correct referral. Multi-patient packets are separated and duplicates are merged.
Extract & Verify
AI reads medical documents and extracts structured data including patient demographics, referring provider details, diagnoses, insurance information, medications, allergies, lab results, and surgical history. The system checks your EHR for existing records and automatically requests any missing documentation.
Authorize & Review
Insurance eligibility is verified by identifying the correct payor and plan. Benefit investigations and prior authorization processing are initiated automatically. Clinical criteria are evaluated against your organization’s guidelines — with your team reviewing and approving before any decision is finalized.
Key Capabilities
Document Inbox
Centralized inbox for all incoming referral documents. Upload directly or receive by fax and email. AI classifies each document automatically, and your team can review, tag, and convert documents into referrals with a single action.
Intelligent Data Extraction
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.
Smart Routing
AI-powered matching of patients to optimal providers based on specialty, location, availability, and patient preferences. Prioritize in-network providers to reduce leakage.
Completeness Scoring
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.
EHR Integration
Connects to your electronic health record system to look up existing patients, create new records, add providers, and write back medications and allergies — keeping your EHR current without manual re-entry.
Insurance & Eligibility Verification
Identifies the correct payor and plan, runs eligibility checks, and surfaces coverage details including copay, coinsurance, deductible remaining, plan type, and prior authorization requirements. Benefit investigations automated end-to-end.
Clinical Review
AI evaluates referral documentation against your organization’s clinical criteria to assess medical necessity. Highlights whether each requirement is met, partially met, or missing — giving reviewers a clear summary to approve or escalate.
Automated Communication
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.
Appointment Scheduling
Book appointments with target providers and facilities directly from within the referral workflow, ensuring referrals convert to scheduled visits without leaving the platform.
Referral Dashboard
Centralized view of all referrals with filtering by urgency level (Routine, Urgent, Stat), workflow stage, patient name, due date, and more. Search across referrals and track progress at a glance.
Network Optimization
Maximize in-network referral rates. Track referrals from submission through completion with automated follow-up and complete visibility into referral status and outcomes.
Analytics & Insights
Track referral volume, processing times, team performance, referral patterns, leakage rates, and provider performance. Identify bottlenecks and measure conversion rates.
Task Management & Workflow
Work Queue Management
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.
Human-in-the-Loop Control
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.
Configurable Workflow
Workflow stages can be enabled or disabled to match your referral process. AI agents can be turned on or off for each stage. Upload your own clinical criteria documents to customize clinical reviews.
Audit Trail
Each task tracks its full history of actions and status changes, maintaining compliance and providing complete accountability across the referral lifecycle.
Use Cases
| Use Case | Description |
|---|---|
| High-Volume Referral Intake | Organizations receiving hundreds of faxed 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 tailored to each site’s processes and requirements |
| Specialty Referrals | Route patients to appropriate specialists within your network based on specialty, location, and availability |
| Facility Transfers | Coordinate transfers between facilities efficiently with complete documentation and handoff tracking |
Platform Integration
skyReferral is part of Skypoint’s composable platform, connecting seamlessly with:- skyStudio — 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