Referrals+ Referral Capture

REFERRAL CAPTURE CHALLENGES

Why Referral Prescriptions are Hard to Capture at Scale

Referral scripts are the hardest claims to capture — and have heavier compliance requirements. Here's why most covered entities haven't yet added referral capture to their 340B strategy.

Referral prescriptions fall outside your standard claim workflow

It's not as simple as "that's my patient". HRSA wants you to prove it with a combination of your last encounter date, and the patient notes from the external provider.

Manufacturer restriction windows don't wait

Under the Rebate Model, restricted drugs have submission windows that close permanently. Without active prioritization, time-sensitive claims may not get worked at all.

Capturing Referral Scripts Takes Time & Effort If you're like most CEs, your team is already has too much to do, especially with the Rebate Model and the related requirements looming in the future.

Referrals+ Fast Facts

"Unknown prescriber" isn't a data problem. It's a revenue problem — and it compounds every month you don't address it. Monthly net value recovered is not a guarantee as savings vary based on capturable claims.

$5-20K Average monthly net 340B value recovered

4 Eligibility control layers

10-30% Typical referral capture rate

OUR SOLUTION

How Referrals+ Fixes Mixed Referral Scripts

Referrals+ combines switch data, human investigation, and configurable rules to turn "provider unknown" claims into compliant 340B savings. Here are five ways Referrals+ recovers value from referral prescriptions you're missing today:

Automated Prescriber Outreach

Referrals+ sends integrated faxes directly to referred-to providers to resolve unknown prescriber flags and validate patient care ownership. Notes are returned to your team - no manual chase, no delay.

Manufacturer Restriction Prioritization

Some claims are on a time-sensitive restriction window. Once it closes, the savings are gone. Referrals+ auto-prioritizes your queue, so your team works the highest-value, time-bound claims first.

HRSA Defensible Audit Trail

Referrals+ captures patient notes, script validation, and last encounter date review as part of compliance documentation, creating an audit-ready record for every captured claim.

Smart Refill Capture

First-fill capture is only half the picture. Referrals+ identifies refill prescriptions tied to prior referral events and automatically pulls them into the capture workflow using patient provider match logic.

Native Contract Pharmacy Integration

Everything captured flows back into your existing workflows. Rejected claims route to Referrals+ automatically. Approved claims are sent back for reprocessing - no parallel process, no extra steps.

THE SOLUTION

Referrals+ layers directly onto your existing PharmaForce platform

No new infrastructure. No disruption to current workflows. Start recovering 340B savings in as little as 2 weeks.

Intelligent claim routing

Ineligible claims from Contract Pharmacy are automatically sent to Referrals+ for review. No manual handoff, no new queue for your team to manage.

Restriction window prioritization

We prioritize the claims most at risk of expiring first — so your team always works what matters most before the window closes.

Patient-Prescriber Memory

Every referral script captured saves time, since new prescriptions between that patient and provider are flagged for streamlined review.

In-depth 340b eligibility review

Our team requests and reviews progress notes from referred-to providers, checks your data for supporting documentation and returners notes to your team.

Streamlined claim reprocessing

Approved claims are reprocessed as 340B claims via Contract Pharmacy integration. Optionally route claims to an approval queue before reprocessing.

Refill Capture That Doesn't Quit

Refill prescriptions tied to prior referral events are pulled into the capture workflow, so value compounds with every fill, not just the first.

4 Compliance & Strategy Controls

Use four simple controls to match referral capture to how you run your 340B program. Set thresholds, define which referrals to chase, and let Referrals+ automatically apply your rules at scale.

Encounter lookback window

Define how recent a provider encounter must be for a claim to qualify. Falls outside your window? Filtered out automatically.

Future refill capture toggle

Turn refill capture on or off program wide. No configuration required.

Expiration lookback window

Set how long after expiration a claim can still be captured. You control the boundary and Referrals+ enforces it on every claim.

Profit threshold

Set a minimum net savings value below which Referrals+ will not capture the claim. No noise, no low-value captures.

REFERRAL CAPTURE, YOUR WAY

Fully Managed Or Platform Only - You Choose The Model That Fits

Referrals+ works for teams that want control and teams that want coverage. Either way, nothing falls through the cracks.

PLATFORM ONLY

Your team runs the queue

Full access to the Referrals+ platform — additional control layers, integrated eFaxing, and reporting. Your pharmacy staff works the claims with better tools and better visibility.

Automated unknown prescriber eFax outreach
Refill linkage and capture
Referral capture rate reporting
Full Contract Pharmacy integration

MANAGED SERVICE

We run the queue for you

Our team acts as an extension of yours — reviewing claims, handling outreach, validating encounters, and sending qualified claims back for 340B capture.

Everything in Platform, plus:
PharmaForce team works the queue on your behalf
Provider documentation outreach and follow-up
HRSA-defensible audit documentation

Turn invisible referral scripts into compliant 340B growth