Referral Acceptance Criteria for Behavioral Health Practices: A Screening Checklist
Most behavioral health practices accept or decline referrals from memory: whoever opens the fax knows, roughly, what the practice takes. That works until it doesn't, and the cost is a patient who waited a week to hear no, or a referral source who stops sending.
Short answer
Referral acceptance criteria are the written rules a practice uses to decide whether it can take a referral: the service requested is one you offer, the patient is in an age range you serve, you take their insurance, the level of care fits, you can see them where they live, and the referral includes contact details and a reason. Check every referral against them on arrival, and send unclear cases to a person.
Why write them down
Written criteria make the decision the same no matter who opens the fax, make it fast enough to reach the patient the same day, and give you a clear, kind answer for the referrals you can't take. They also make the check something software can run.
The checklist
| Criterion | What to check | Where it usually goes wrong |
|---|---|---|
| Service offered | The requested service, such as outpatient psychiatry, therapy, or testing, is one you provide | A vague reason for referral |
| Age range | The patient's age is within the ranges your clinicians serve | Missing date of birth; minors needing a guardian |
| Insurance | You take the patient's plan, and a clinician who fits is credentialed with it | Carve-outs and Medicaid managed care plans |
| Level of care | Outpatient care is appropriate, rather than a higher level | Acuity that only shows up in records |
| Location and licensure | The patient is in a state where your clinicians are licensed, including for telehealth | Telehealth across state lines |
| Required details | Patient contact information, referring provider and their contact information, and a reason | Faxes with no patient phone number |
| Capacity | Someone suitable has openings in a reasonable time | Accepting into a long waitlist without saying so |
What needs a person
Rules settle most referrals. Some need judgment: a referral that suggests a higher level of care, unclear or partial documents, a clinical exclusion, or an exception you might make for a referral partner. Those should go to a clinician or intake coordinator with the original document attached, not be decided by default.
When you can't take it
Tell the referral source and the patient quickly, and point them to another option if you can. More in referral management for group practices.
Running the check automatically
Stable reads each referral fax, extracts the patient details, and checks them against your acceptance rules, such as the service requested, the age range, and whether contact information is present, keeping the original fax beside the extracted fields. For referrals that pass, it texts the patient to confirm interest, collects both sides of the insurance card, and runs a benefits check. Unclear documents and rules that need judgment go to a person in the same conversation. See fax referral intake and the behavioral health CRM.
Frequently asked questions
What are referral acceptance criteria?
The written rules a practice uses to decide whether it can take a referral, such as services offered, age range, insurance, level of care, licensure, and the information the referral must include.
What should a behavioral health referral include?
At minimum: patient name, date of birth, phone number, insurance, the reason for referral, and the referring provider's name and contact details. Records help with level-of-care decisions.
Can referral screening be automated?
The rule-based checks can. Stable extracts details from referral faxes and checks them against your rules, then sends anything unclear or judgment-based to a person.
How fast should a practice respond to a referral?
The same day where possible. Patients referred for mental health care often contact more than one practice, and a quick yes or no keeps referral sources sending.
Every referral screened the day it arrives.
See Stable read a referral fax, check your rules, and reach the patient by text.
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