Coordinating a rehabilitation referral between GP, insurer and provider

Referral is not approval

A referral is a clinical request that a service be provided. An approval is a funder's decision that the service will be paid for under the claim or plan. A provider can hold a valid referral and still be unable to start, because the funding step has not happened.

Say which of the two you are asking for when you contact anyone. 'Has the referral been received?' and 'has the treatment request been approved?' are different questions with different owners.

Who owns what

• Treating practitioner: diagnosis, current capacity certification, clinical goals, the referral itself.
• Worker or patient: consent, contact details, availability, and the practical facts about their job or home situation.
• Employer or return-to-work coordinator (work injury): duties available, site access, supervision.
• Insurer or case manager: claim status, approval of the requested service, session limits, fee position.
• Rehabilitation provider: acknowledging the referral, booking, delivering the service and reporting back.
• Get Rehab: collecting the referral information and connecting the person with a suitable participating provider — not deciding eligibility, funding, legal rights or clinical suitability.

Use the scheme's own process where one exists

Where a scheme publishes a treatment request or management plan process, using it is usually the fastest route. In Queensland, for example, WorkCover Queensland publishes treatment and approval requirements for allied health providers and uses provider management plans for planned treatment (a Queensland-specific arrangement). In South Australia, ReturnToWorkSA publishes healthcare and treatment information for claims and separately describes return-to-work services.

In the Commonwealth scheme, Comcare publishes rehabilitation guidance and the requirements applying to workplace rehabilitation providers. In NSW, SIRA publishes the workplace rehabilitation provider approval framework and a provider search. None of these are national rules — check the one that governs the claim in front of you.

Consent that actually covers the handover

Consent obtained for treatment does not automatically cover three-way disclosure between a treating practice, an insurer, an employer and a new provider. Record consent that names the parties and the purpose, note the date, and note how the person can withdraw it.

• Who may share information: treating practice, provider, insurer, employer contact.
• What may be shared: capacity and duties information, progress reports, relevant clinical history.
• What is excluded, if the person asks for something to be withheld.
• How long the consent applies and how to withdraw it.

The handover itself

• Send the referral to a named person or a monitored intake channel, not an individual clinician's personal inbox.
• State the funding pathway, claim or plan number, and the approval status you know of.
• Attach the current capacity certificate and any scheme form the service requires.
• Ask for an acknowledgement with an expected first-appointment date.
• Book the review point before the approved sessions run out.
• Confirm who receives progress reports, and in what format.

A hypothetical coordination sequence

A hypothetical GP refers a patient with a work-related knee injury for physiotherapy. The referral goes to a provider intake address with the claim number, the current certificate and a note that approval has been requested but not confirmed. The provider acknowledges within a day and offers two appointment slots subject to approval. The case manager confirms approval two days later and the earlier slot is taken. The review is booked in the same email. Illustrative only — it describes no real patient and guarantees no timeframe or funding outcome.