Submitting a Referral

Submitting a referral is a 4-step process. A progress indicator at the top shows where you are.

Step 1: Patient Information

Fill in the patient's details:

Required fields:

• First Name, Last Name
• Date of Birth
• Gender (Male, Female, Other)
• Phone Number (with country code)

Optional fields:

• MRN / Patient ID
• SSN / National ID
• Email

Payment Information (required): Choose the payment type:

• Commercial / Private Insurance
• Government Programs (Medicare, Medicaid, CHIP, TRICARE, VA)
• Workers' Compensation
• Auto Accident / Personal Injury
• Self-Pay
• Other

For insurance patients, you'll also enter:

• Payer / Insurer Name
• Group Number and Member / Policy Number
• Payer ID
• Provider Services Phone
• Relationship to Insured
• Billing Address and Contact Information

Special Notes: Add any additional information the imaging facility should know.

Click "Next: Clinical Info" to continue.

Step 2: Clinical Information

This is where you describe what imaging is needed and why.

Requested Exam (required):

• Imaging Facility — Select which facility will perform the study
• Modality — Choose the imaging type: X-Ray (DX/CR), CT, MRI, Ultrasound, Mammography, PET, ECG, Nuclear Medicine, Fluoroscopy, Angiography, or Other
• Body Parts — Search and select one or more body regions to be imaged. You can also type a custom body part if yours isn't listed.
• Clinical History — Describe the patient's relevant clinical history and reason for the referral (10–5,000 characters)

Contrast (if applicable):

• Without Contrast / With Contrast / With & Without / Unspecified
• Route of Administration (IV, Oral, Rectal, Intrathecal)
• Contrast Agent
• Protocol Instructions

Referral Source:

• Referring Facility
• Referring Physician

Supporting Documents: Upload any relevant documents (PDF, JPG, or PNG, max 5 MB each). For each document, select its type:

• Radiology Report, Lab Report, Medical History, Prescription, Discharge Summary, Operative Report, or Other

AI Assistant

On the right side of the screen, the AI Assistant helps with medical coding:

• RI-RADS Score — The system grades your referral's clinical completeness from A (best) to D:

• A — Complete Clinical Context (green): All necessary information provided
• B — Partial Clinical Context (blue): Most information present
• C — Missing Clinical Context (amber): Key clinical details missing
• D — Clinically Unsupported (red): Insufficient clinical justification

• Suggested ICD-10 Codes — AI-recommended diagnosis codes based on your clinical history. You can add or remove individual codes, or click "Add All."

• Suggested CPT Codes — AI-recommended procedure codes. Same add/remove functionality.

Click "Review Referral" to trigger the AI analysis, then "Next: Safety" to continue.

Step 3: Safety Screening

Complete the patient safety questionnaire. The fields shown depend on the patient and modality.

Pregnancy Status (female patients only):

• Currently pregnant / Breastfeeding
• Last menstrual period date

Allergies:

• Previous reaction to iodine or gadolinium contrast
• History of asthma
• Multiple severe allergies or anaphylaxis
• Known allergies (with details)

Medical History:

• Kidney disease / Renal failure / Dialysis
• Renal function test results (eGFR, Creatinine, Lab Date)
• Pheochromocytoma
• Sickle cell disease / Myeloma
• Diabetes / Taking Metformin

Implants & Foreign Bodies:

• Pacemaker, Defibrillator, Cochlear Implant, Insulin Pump, Neurostimulator, Joint Replacement, Surgical Clips/Staples, Dental Implants, Other
• Metal fragments in eyes
• Shrapnel / bullets / metallic foreign bodies

Other Concerns:

• Inability to lie still
• Claustrophobia
• Additional safety notes

Click "Next: Review" to continue.

Step 4: Review & Submit

The review page shows all information you've entered in a summary view:

1. Referral Quality Assessment — Your RI-RADS grade and whether the referral is "Ready to Submit" or requires action
2. Patient Information — Name, DOB, phone, gender, MRN
3. Clinical Information — Modality, body parts, contrast, clinical history, safety summary
4. Payer Information — Payment type, insurance details
5. Referral Information — Imaging facility, radiologist, referring physician

Submitting:

• For insurance patients: Click "Submit Prior Authorization"
• For self-pay / other: Click "Submit Referral"

If your referral has a low quality grade (C or D) or unresolved issues, a warning will appear. You can go back to fix the issues or proceed anyway.

After successful submission, you'll see a confirmation with the option to return to your dashboard.