NCQA Comment on Referral elements: For USCDI v5

  1. Referral Category (new element submission)
  2. Referral Code
  3. Reason for Referral

NCQA recommends adding a distinct Referrals Data Class to USCDI. This class should include the referral category, for example a procedure, an intervention such as counseling or education, or a service. It should also include a code for the specific service requested specified by SNOMED. We recommend reclassifying the reason for referral element from the procedure data class to this new referral class, as not all referrals are for procedures.

This data class and information are important for the efficient exchange of health information to support care coordination and are already routinely exchanged. Inclusion of specific referral information in the USCDI should also facilitate the ability to close the loop on referrals to ensure services requested are carried out, and care is provided, which is the critical step for high-quality, equitable care.

NCPDP Comment

NCPDP recommends ONC to add NCPDP SCRIPT Standard Version 2021011 and the list of acceptable transactions: ServiceReferralRequest, ServiceReferralResponse, RequestForServiceReferral, ResponseToServiceReferralDenied and ServiceDocumenation.

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