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The UM Referral Process

Saint Louis ConnectCare’s Utilization Management Department (UM), is responsible for the direction of patients and the flow of medical information from the PCP to the Specialty and Ancillary Service Areas. UM must process all referrals for patients who qualify for services. Referrals will be processed within 72 hours of receipt, when required documentation is available. Please note the following process:

PCP/Service Area

Health Centers

  • Patient assessed and need for referral to Specialty determined.
  • Complete all required fields on referral form and sign. Please include any supporting documentation, labs, imaging, etc.

Give referral appointment card to patient and instruct patient to call SLCC Call Center at 314-879-6369 to schedule an appointment.

PCP site Referral Coordinators
  • Review all referral forms for completeness.
  • Fax referral forms to the UM Department at 314-879-6342
  • Fax Radiology referral forms to the Radiology Department at 314-879-6469
SLCC Referral Department
  • Receives faxed referrals daily and logs into database
  • Faxes a log of referrals received to each PCP site at end of each business day.
  • Referral Coordinator completes authorization, and delivers referral to specialty clinic.

Inpatient Stays

Non-emergent/Scheduled Admissions

  • Provider will complete referral form
  • Referral Point Person will review for completeness and fax to UM Department at least 5 day’s prior to admission date.
  • UR nurse will review referral for medical necessity per Interqual criteria, assign authorization number, contact admitting hospital to give authorization number.
  • UR nurse will notify Referral Point Person at referring site of approval/denial/or request for more information.
Emergency Admission
  • Hospital will notify UM within 48 hrs of admission.
  • UR nurse will notify Referral Point Person at PCP site to verify patient eligibility.
  • Referral Point Person at PCP site will fax a completed referral form to UM Department indicating that the patient has been seen within a year.
  • If patient is eligible for services UR nurse will obtain clinical information and review for medical necessity per Interqual, and issue an authorization.
  • 5. If the patient is referred to the ER directly from the PCP’s office, the Referral
  • Point Person must complete the referral form in order to notify UM.