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API reference
Redox Data Models
Referral
AuthReview

Referral

This data model communicates patient demographic and clinical information from a referring provider to send the patient's case to another provider.

This typically differs from a consultation, where a provider may review a patient without assuming authority over the patient’s care. Referrals can be internal to an organization (e.g., from one department to another) or external between organizations.

A referral is useful to maintain the administrative aspects of a referral order. You can receive notifications when:

  • A new referral order is placed.
  • An existing referral order is modified or canceled.
  • An authorization review is requested or responded to.

Or, you can search for referral orders based on a patient's demographic and insurance information.

AuthReview

Receive a notification when a provider requests authorization for a referral from a payer or other third party.

The Referral object is deprecated in favor of the Authorization object.

Beta

Request Body Schema

  • Meta
    required, object
    • DataModel
      required, string
      Reliable

      Referral

    • EventType
      required, string
      Reliable

      AuthReview

    • EventDateTime
      string, null
      Reliable

      Displays the UTC date and time that an outgoing request is delivered or an incoming request is received.
      ISO 8601 Format

    • Test
      boolean, null
      Reliable

      Indicates whether the request is a test or not.

    • Source
      object

      Contains the information for the system initiating the message, including the source ID and name.
      Included in messages from Redox

      • ID
        string, null
        Reliable

        Identifies the system initiating the message. If you have multiple OAuth API keys per environment type, this value is required. If you have only one OAuth API key per environment type, or you're using legacy API keys, this value is optional.
        UUID

      • Name
        string, null
        Reliable

        Displays the name of the system initiating the message.

    • Destinations
      Array of object

      Contains the information for the endpoint(s) receiving the request. A request must contain at least one destination, but asynchronous requests can have more than one destination. Synchronous requests like queries can only support one destination.
      Required when sending data to Redox.

      • ID
        string, null
        Reliable

        Identifies the endpoint that the request is directed to.
        UUID

      • Name
        string, null
        Reliable

        Displays the name of the endpoint that the request is directed to.

    • Logs
      Array of object

      Contains the log identifier(s) for the request.

      • ID
        string, null
        Reliable

        Identifies the request log(s) that correspond to this request. You can use this value to locate the relevant log in the Redox dashboard for support and reference.
        UUID

      • AttemptID
        string, null
        Reliable

        Identifies the request log attempt value, which is useful when retries are possible.
        UUID

    • FacilityCode
      string, null
      Possible

      Code for the facility related to the message.
      Only use this field if a health system indicates you should. The code is specific to the health system's EHR and might not be unique across health systems. In general, the facility fields within the data models (e.g. OrderingFacility) are more reliable and informative.

  • Patient
    required, object
    • Identifiers
      required, Array of object

      List of IDs and ID types that identify the patient

      • ID
        required, string
        Reliable

        ID for the patient

      • IDType
        required, string
        Reliable

        Type of ID.
        E.g. MRN, EPI

    • Demographics
      object
      • FirstName
        string, null
        Reliable

        Patient's first name

      • MiddleName
        string, null
        Possible

        Patient's middle name or middle initial. For patients with multiple middle names, all their middle names are included in this field.

      • LastName
        string, null
        Reliable

        Patient's last name

      • DOB
        string, null
        Reliable

        Patient's date of birth.
        In ISO 8601 format

      • SSN
        string, null
        Probable

        Patient's social security number

      • Sex
        string, null
        Reliable
        Value Set

        Patient's sex

      • Race
        string, null
        Possible
        Value Set

        Patient's race

      • IsHispanic
        boolean, null
        Possible
        Value Set

        Indicates if the patient is of hispanic origin.

      • Religion
        string, null
        Possible
        Value Set

        Patient's religious affiliation

      • MaritalStatus
        string, null
        Possible
        Value Set

        Patient's marital status

      • IsDeceased
        boolean, null
        Possible

        Indicates if the patient is deceased

      • DeathDateTime
        string, null
        Possible

        Date and Time the patient was proclaimed deceased.
        ISO 8601 Format

      • PhoneNumber
        object
        • Home
          string, null
          Probable

          Patient's home phone number.
          In E. 164 Format. (e.g. +16085551234)

        • Office
          string, null
          Probable

          Patient's office phone number.
          In E. 164 Format. (e.g. +16085551234)

        • Mobile
          string, null
          Probable

          Patient's mobile phone number.
          In E. 164 Format. (e.g. +16085551234)

      • EmailAddresses
        Array of string

        Patient's email address(es)

      • Language
        string, null
        Possible
        Value Set

        Patient's primary spoken language.
        In ISO 639-1 alpha values (e.g. 'en'). Supported Values

      • Citizenship
        Array of string

        Patient's nation(s) of citizenship.
        In ISO 3166 alpha 2 format (e.g. 'US').

      • Address
        object

        Patient's home address

        • StreetAddress
          string, null
          Probable

          Street address

        • City
          string, null
          Probable

          City

        • State
          string, null
          Probable

          State

        • ZIP
          string, null
          Probable

          ZIP

        • County
          string, null
          Possible

          County

        • Country
          string, null
          Possible
          Value Set

          Country

    • Notes
      Array of string

      Patient-level notes

    • Insurances
      Array of object

      List of insurance coverages for the patient

      • Plan
        object
        • ID
          string, null
          Probable

          Identifier of insurance plan

        • IDType
          string, null
          Probable

          ID type of insurance plan

        • Name
          string, null
          Probable

          Name of insurance plan

        • Type
          string, null
          Possible

          Type of insurance plan

      • MemberNumber
        string, null
        Possible

        Patient member number

      • Company
        object
        • ID
          string, null
          Probable

          ID of insurance company (payor)

        • IDType
          string, null
          Probable

          ID type of insurance company (payor)

        • Name
          string, null
          Probable

          Name of insurance company (payor)

        • Address
          object

          Insurance company's address

          • StreetAddress
            string, null
            Probable

            Street address

          • City
            string, null
            Probable

            City

          • State
            string, null
            Probable

            State

          • ZIP
            string, null
            Probable

            ZIP

          • County
            string, null
            Possible

            County

          • Country
            string, null
            Possible
            Value Set

            Country

        • PhoneNumber
          string, null
          Probable

          Insurance companys phone number.
          In E. 164 Format (i.e. +16085551234)

      • GroupNumber
        string, null
        Probable

        Insurance policy group number

      • GroupName
        string, null
        Probable

        Insurance policy group name

      • EffectiveDate
        string, null
        Probable

        Effect date of this insurance policy.
        In YYYY-MM-DD format

      • ExpirationDate
        string, null
        Probable

        Expiration date of this insurance policy.
        In YYYY-MM-DD format

      • PolicyNumber
        string, null
        Probable

        Insurance policy number

      • Priority
        string, null
        Possible
        Value Set

        The insurance priority sequence.
        If the insurance works in conjunction with other insurance plans, this field contains priority sequence.

      • AgreementType
        string, null
        Probable
        Value Set

        Type of insurance agreement.

      • CoverageType
        string, null
        Probable
        Value Set

        Type of insurance agreement.
        Indicates who will be receiving the bill for the service.

      • Insured
        object

        Individual who has the agreement with the insurance company for the related policy

        • Identifiers
          Array of object

          List of IDs and ID types that identify the insured

          • ID
            string, null
            Possible

            ID for the insured

          • IDType
            string, null
            Possible

            Type of ID.
            E.g. MRN, EPI

        • LastName
          string, null
          Possible

          Last name of the insured

        • MiddleName
          string, null
          Possible

          Middle name of the insured

        • FirstName
          string, null
          Possible

          First name of the insured

        • SSN
          string, null
          Possible

          Insured's social security number

        • Relationship
          string, null
          Possible
          Value Set

          Relationship of the insured to the patient

        • DOB
          string, null
          Possible

          Date of birth of the insured.
          In YYYY-MM-DD format

        • Sex
          string, null
          Possible
          Value Set

          Sex of the insured

        • Address
          object

          Address of the insured

          • StreetAddress
            string, null
            Probable

            Street address

          • City
            string, null
            Probable

            City

          • State
            string, null
            Probable

            State

          • ZIP
            string, null
            Probable

            ZIP

          • County
            string, null
            Possible

            County

          • Country
            string, null
            Possible
            Value Set

            Country

  • Referral
    object
    • ID
      string, null
      Reliable

      The Health System ID of the referral

    • IDType
      string, null
      Reliable

      The ID type

    • AlternateID
      string, null
      Reliable

      The alternate ID of the referral, often used by external/3rd party systems

    • Type
      string, null
      Reliable
      Value Set

      The type of the referral

    • Category
      string, null
      Reliable
      Value Set

      The category of the referral

    • Priority
      string, null
      Reliable
      Value Set

      The priority of the referral

    • Status
      string, null
      Reliable
      Value Set

      The status of the referral

    • DateTime
      string, null
      Reliable

      The date and time the referral is considered active.
      ISO 8601 Format

    • ExpirationDateTime
      string, null
      Reliable

      The date and time the referral expires.
      ISO 8601 Format

    • ProcessDateTime
      string, null
      Reliable

      The date and time the referral was processed.
      ISO 8601 Format

    • Reason
      string, null
      Probable
      Value Set

      The reason for the referral

    • ProviderSpecialty
      string, null
      Possible

      The provider specialty of the referral

    • DepartmentSpecialty
      string, null
      Possible

      The department specialty of the referral

    • Notes
      Array of string

      Referral Notes

    • Authorization
      object
      • Plan
        object
        • ID
          string, null
          Possible

          The ID of the plan

        • IDType
          string, null
          Possible

          The ID type

        • Name
          string, null
          Possible

          The name of the plan

      • Company
        object
        • ID
          string, null
          Possible

          The ID of the payor

        • IDType
          string, null
          Possible

          The ID type

        • Name
          string, null
          Possible

          The name of the payor

      • DateTime
        string, null
        Possible

        The date and time the authorization is effective.
        ISO 8601 Format

      • ExpirationDateTime
        string, null
        Possible

        The date and time the authorization expires.
        ISO 8601 Format

      • Number
        string, null
        Possible

        The identifier for the authorization assigned by the payor

      • ReimbursementLimit
        string, null
        Possible

        The reimbursement limit for this referral

      • RequestedTreatmentCount
        string, null
        Possible

        The number of treatments requested

      • RequestedTreatmentUnits
        string, null
        Possible

        The units associated to the treatment count.
        e.g. 'instances' or 'days'

      • AuthorizedTreatmentCount
        string, null
        Possible

        The number of treatments authorized

      • Notes
        Array of string

        Notes about the authorizations

    • Diagnoses
      Array of object

      List of diagnoses

      • Code
        string, null
        Probable

        Code for the diagnoses

      • Codeset
        string, null
        Probable
        Value Set

        Code set used to identify the diagnoses.
        One of the following: ICD-9, ICD-10, HCPCS, CPT

      • Name
        string, null
        Probable

        Name of the diagnoses

      • Type
        string, null
        Possible
        Value Set

        Type of the diagnosis

      • DocumentedDateTime
        string, null
        Possible

        DateTime the diagnoses was documented.
        ISO 8601 Format

      • Notes
        Array of string

        Notes about the diagnosis

    • Procedures
      Array of object

      Ordered procedure

      • Code
        string, null
        Reliable

        Code for the procedure

      • Codeset
        string, null
        Reliable

        Code set used to identify the procedure.
        CPT, HCPCS, SNOMED, or LOINC. If no code set is specified, a health system specific identifier is being used.

      • Description
        string, null
        Reliable

        Description of the procedure

      • Notes
        Array of string

        Notes about the procedure

      • Quantity
        string, null
        Possible

        Number of instances for the procedure

      • Units
        string, null
        Possible

        Related units associated to the procedure quantity

      • Modifiers
        Array of string

        Associated procedure modifiers

    • Providers
      Array of object
      • ID
        string, null
        Possible

        ID of the provider.
        This ID is often required for Inpatient Visits.

      • IDType
        string, null
        Possible

        ID type of the ID for the provider

      • FirstName
        string, null
        Possible

        First name of the undefined

      • LastName
        string, null
        Possible

        Last name of the undefined

      • Credentials
        Array of string

        List of credentials for the undefined.
        e.g. MD, PhD

      • Address
        object

        Provider's address

        • StreetAddress
          string, null
          Possible

          Street address

        • City
          string, null
          Possible

          City

        • State
          string, null
          Possible

          State

        • ZIP
          string, null
          Possible

          ZIP

        • County
          string, null
          Possible

          County

        • Country
          string, null
          Possible
          Value Set

          Country

      • EmailAddresses
        Array of string

        Provider's email address(es)

      • PhoneNumber
        object
        • Office
          string, null
          Possible

          Provider's office phone number.
          In E. 164 Format. (e.g. +16085551234)

      • Type
        string, null
        Possible
        Value Set

        The type of provider

      • ContactInfo
        string, null
        Possible

        Additional contact information for this provider

      • Location
        object

        Provider's location

        • Type
          string, null
          Possible

          Type of location.
          Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone

        • Facility
          string, null
          Possible

          Facility.
          Example: Community Hospital

        • FacilityIdentifiers
          Array of object

          List of IDs specific to this facility

          • ID
            string, null
            Possible

            An ID specific to this facility

          • IDType
            string, null
            Possible

            The source or system to which this ID pertains.
            Could be an OID or a human-readable name

        • Department
          string, null
          Possible

          Department

        • DepartmentIdentifiers
          Array of object

          List of IDs specific to this department

          • ID
            string, null
            Possible

            An ID specific to this department

          • IDType
            string, null
            Possible

            The source or system to which this ID pertains.
            Could be an OID or a human-readable name

        • Room
          string, null
          Possible

          Room.
          Example: 136

    • Visit
      object
      • VisitNumber
        string, null
        Possible

        Visit Number.
        Unique ID of the visit associated to the referral

    • ServiceLocation
      string, null
      Possible
      Value Set

      Code characterizing the location where the referral or service is to take place.

    • RequestType
      string, null
      Reliable
      Value Set

      Code indicating the type of request.

    • RelatedCause
      string, null
      Possible
      Value Set

      Code indicating a related illness or injury.

  • Authorization
    object
    • Request
      object
      • ID
        string, null
        Reliable

        The requesting system's ID for the authorization review request

      • IDType
        string, null
        Reliable

        The requesting system's ID type for the authorization review request

    • AlternateID
      string, null
      Possible

      The alternate ID of the authorization review request, often used by external/3rd party systems

    • Type
      string, null
      Reliable
      Value Set

      The type of authorization request

    • Category
      string, null
      Reliable
      Value Set

      The category of authorization request

    • CertificationCode
      string, null
      Reliable
      Value Set

      The type of certification being sought by the requestor

    • ServiceType
      string, null
      Reliable
      Value Set

      The type of service associated to the authorization request

    • ServiceLocation
      string, null
      Reliable
      Value Set

      The priority of the referral

    • RelatedCause
      string, null
      Possible
      Value Set

      Code indicating a related illness or injury.
      One of the following: Accident, Employment, Other

    • ServiceLevel
      string, null
      Reliable
      Value Set

      The priority of the referral

    • EventDate
      string, null
      Reliable

      The expected date of the requested service.
      ISO 8601 Format

    • Quantity
      object
      • Value
        string, null
        Reliable

        Requested quantity

      • Units
        string, null
        Reliable

        Associated units to requested quantity

    • AdmissionSource
      string, null
      Possible
      Value Set

      Code indicating the source of an inpatient admission

    • AdmissionType
      string, null
      Possible
      Value Set

      Code indicating the type of inpatient admission.

    • AdditionalDates
      Array of object

      Collection of additional dates related to the authorization

      • DateTime
        string, null
        Probable

        ISO 8601 Format

      • Type
        string, null
        Probable
        Value Set

        Type of date value.
        e.x. Service Period Start (https://ushik.ahrq.gov/ViewItemDetails?system=sdo&itemKey=133121000)

    • Diagnoses
      Array of object

      List of diagnoses

      • Code
        string, null
        Probable

        Code for the diagnosis

      • Codeset
        string, null
        Probable
        Value Set

        Code set used to identify the diagnosis.
        One of the following: ICD-9, ICD-10, HCPCS, CPT

      • Name
        string, null
        Probable

        Name of the diagnosis

      • Type
        string, null
        Possible
        Value Set

        Type of the diagnosis

      • DocumentedDateTime
        string, null
        Possible

        DateTime the diagnosis was documented.
        ISO 8601 Format

    • Notes
      Array of string

      Notes about the authorization

    • Services
      Array of object

      Services included in the authorization review

      • Code
        string, null
        Reliable

        Code for the service line

      • Codeset
        string, null
        Reliable

        Code set used to identify the service line.
        CPT, HCPCS, SNOMED, or LOINC. If no code set is specified, a health system specific identifier is being used.

      • Description
        string, null
        Reliable

        Description of the service line

      • RevenueCode
        string, null
        Probable

        Institutional Revenue Code

      • Quantity
        object
        • Value
          string, null
          Reliable

          Requested service line quantity

        • Units
          string, null
          Reliable

          Associated units to the requested quantity

      • Modifiers
        Array of string

        Service line modifiers

      • ServiceDate
        string, null
        Probable

        The date the service line is to be performed, if different than the authorization's event date.
        ISO 8601 Format

      • Notes
        Array of string

        Notes about the service line

    • Providers
      Array of object
      • ID
        string, null
        Possible

        ID of the provider.
        This ID is often required for Inpatient Visits.

      • IDType
        string, null
        Possible

        ID type of the ID for the provider

      • FirstName
        string, null
        Possible

        First name of the undefined

      • LastName
        string, null
        Possible

        Last name of the undefined

      • Credentials
        Array of string

        List of credentials for the undefined.
        e.g. MD, PhD

      • Address
        object

        Provider's address

        • StreetAddress
          string, null
          Possible

          Street address

        • City
          string, null
          Possible

          City

        • State
          string, null
          Possible

          State

        • ZIP
          string, null
          Possible

          ZIP

        • County
          string, null
          Possible

          County

        • Country
          string, null
          Possible
          Value Set

          Country

      • EmailAddresses
        Array of string

        Provider's email address(es)

      • PhoneNumber
        object
        • Office
          string, null
          Possible

          Provider's office phone number.
          In E. 164 Format. (e.g. +16085551234)

      • Type
        string, null
        Possible
        Value Set

        The type of provider

      • ContactInfo
        string, null
        Possible

        Additional contact information for this provider

      • Location
        object

        Provider's location

        • Type
          string, null
          Possible

          Type of location.
          Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone

        • Facility
          string, null
          Possible

          Facility.
          Example: Community Hospital

        • FacilityIdentifiers
          Array of object

          List of IDs specific to this facility

          • ID
            string, null
            Possible

            An ID specific to this facility

          • IDType
            string, null
            Possible

            The source or system to which this ID pertains.
            Could be an OID or a human-readable name

        • Department
          string, null
          Possible

          Department

        • DepartmentIdentifiers
          Array of object

          List of IDs specific to this department

          • ID
            string, null
            Possible

            An ID specific to this department

          • IDType
            string, null
            Possible

            The source or system to which this ID pertains.
            Could be an OID or a human-readable name

        • Room
          string, null
          Possible

          Room.
          Example: 136

Example
json
1
{
2
  "Meta": {
3
    "DataModel": "Referral",
4
    "EventType": "AuthReview",
5
    "EventDateTime": "2024-11-20T14:08:29.777Z",
6
    "Test": true,
7
    "Source": {
8
      "ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
9
      "Name": "Redox Dev Tools"
10
    },
11
    "Destinations": [
12
      {
13
        "ID": "af394f14-b34a-464f-8d24-895f370af4c9",
14
        "Name": "Redox EMR"
15
      }
16
    ],
17
    "Logs": [
18
      {
19
        "ID": "d9f5d293-7110-461e-a875-3beb089e79f3",
20
        "AttemptID": "925d1617-2fe0-468c-a14c-f8c04b572c54"
21
      }
22
    ],
23
    "FacilityCode": null
24
  },
25
  "Referral": {
26
    "ID": null,
27
    "IDType": null,
28
    "AlternateID": null,
29
    "Type": null,
30
    "Category": null,
31
    "Priority": null,
32
    "Status": null,
33
    "DateTime": null,
34
    "ExpirationDateTime": null,
35
    "ProcessDateTime": null,
36
    "Reason": null,
37
    "ProviderSpecialty": null,
38
    "DepartmentSpecialty": null,
39
    "Notes": [],
40
    "Authorization": {
41
      "Plan": {
42
        "ID": null,
43
        "IDType": null,
44
        "Name": null
45
      },
46
      "Company": {
47
        "ID": null,
48
        "IDType": null,
49
        "Name": null
50
      },
51
      "DateTime": null,
52
      "ExpirationDateTime": null,
53
      "Number": null,
54
      "ReimbursementLimit": null,
55
      "RequestedTreatmentCount": null,
56
      "RequestedTreatmentUnits": null,
57
      "AuthorizedTreatmentCount": null,
58
      "Notes": []
59
    },
60
    "Diagnoses": [],
61
    "Procedures": [],
62
    "Providers": [],
63
    "Visit": {
64
      "VisitNumber": null
65
    },
66
    "ServiceLocation": null,
67
    "RequestType": null,
68
    "RelatedCause": null
69
  },
70
  "Authorization": {
71
    "Request": {
72
      "ID": "4356789876",
73
      "IDType": null
74
    },
75
    "AlternateID": "2133311",
76
    "Type": "Professional",
77
    "Category": "Procedure",
78
    "CertificationCode": "Initial",
79
    "ServiceType": "Medical Care",
80
    "ServiceLocation": "On Campus - Outpatient Hospital",
81
    "RelatedCause": null,
82
    "ServiceLevel": null,
83
    "EventDate": "2021-05-25",
84
    "Quantity": {
85
      "Value": "1",
86
      "Units": "Visit"
87
    },
88
    "AdmissionSource": null,
89
    "AdmissionType": null,
90
    "AdditionalDates": [],
91
    "Diagnoses": [],
92
    "Notes": [],
93
    "Services": [
94
      {
95
        "Code": "400500400",
96
        "Codeset": "CPT4",
97
        "Description": "Anticoag Therapy Referral",
98
        "RevenueCode": null,
99
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