In most medical offices, one fax number receives everything. Referrals from primary care, results from the reference lab, decisions from payers, refill requests from pharmacies, records requests from attorneys and the occasional advertisement all arrive in the same place. Somebody has to look at each page and decide who needs it. That sorting step is invisible until the person who does it is out sick.
Routing is the practice of deciding, ahead of time, where each kind of fax should go. It does not have to start with automation. The most effective first steps are organizational, and they work on day one.
Start with what arrives
Before changing anything, spend a week noting what comes in by fax and who acts on it. You do not need precise counts. You need the categories and the owners. A typical list:
- referrals and consult requests;
- lab, imaging and pathology results;
- prior authorization decisions and payer correspondence;
- pharmacy refill requests and clarifications;
- medical records requests and responses;
- hospital discharge summaries and care coordination notes; and
- everything else.
For each category, write down who should see it first and who should never need to see it. That second column matters. HIPAA's minimum necessary implementation asks a practice to identify those persons or classes of persons in its workforce who need access to protected health information to do their jobs. A routing plan is the operational form of that decision. Our article on minimum necessary access for shared fax inboxes covers the reasoning in more depth.
Three levels of routing
Routing options build on each other. Most practices get most of the benefit from the first two.
Level one: route by number
The simplest and most reliable rule is to give different senders different numbers. A referral number published to referring offices, an authorizations number given to payers and a records number on your release of information forms will each collect one kind of document. Nobody has to read a page to decide where it goes, because the sender has already decided by choosing the number.
Keep the main number as the catch all. Anything that arrives there is triaged by a named person, and repeat senders who use it can be given the right number for next time.
Level two: route by recipient
Each number then needs a destination. With fax-to-email, an incoming fax is converted into a digital document and delivered to designated recipients. A number can go to one person, a team or a shared mailbox. Our explainer on how email-to-fax works covers the mechanics in both directions.
The design question at this level is ownership. A destination that several people can see needs a rule about who claims each fax, or every fax is everybody's and nobody's. Our guide to shared fax inboxes for front desk, billing and clinical staff covers claiming, backup coverage and end of day checks.
Level three: route by rule
Beyond number and recipient, a practice can apply workflow rules: notifying a coordinator when a fax arrives from a particular sender, moving documents to a filing location, or flagging items that have not been handled within a set time. Rules like these are useful, but they are custom work. They depend on your practice's systems and processes, they need testing against real document flow, and a rule that misfires can send patient information to the wrong place at machine speed. Treat them as a project with requirements, testing and an owner, after levels one and two are working.
Publish the right numbers
Routing by number only works if senders know which number to use. Plan the change the way you would plan a phone number change:
- Update your referral forms, release of information forms, letterhead and fax cover sheets.
- Tell your highest volume senders directly: your main referral partners, the labs you use and the payers you work with most.
- Update online directories and payer portals where your fax number appears.
- Keep the old number active as the catch all, so a sender who did not get the message still reaches you.
Expect a transition period. For several weeks, a share of each category will still arrive on the main number. That is normal, and it is a useful list of senders who need a reminder.
Give every destination an owner and a backup
A routing plan fails quietly when a destination has nobody watching it. For each one, name a primary owner, a backup, the expected response time and what happens outside office hours. A referral inbox checked twice a day and a results inbox checked hourly may both be right for your practice, but the decision should be written down rather than habitual.
The Security Rule's technical safeguards also come into play here. Unique user identification and access control are what make a destination's audience match the plan, and audit controls are what let you check later that it did.
Check that it is working
After the first month, look at three things. Which categories still arrive mostly on the main number? Which destinations have faxes that waited longest before someone handled them? And how often did a fax have to be moved from one destination to another? Each answer points at a specific fix: a sender to remind, an owner to back up or a category to split. Referrals and authorizations usually repay the most attention, and our article on referrals and prior authorizations by fax covers how to track them from sent to answered.
Where LABUSA eFaaS fits
With LABUSA eFaaS, each fax number is delivered to the email recipients you designate, and a number can be routed to an individual, a department or a shared destination. Dedicated and toll free numbers are available for practices that want a separate number per purpose, and existing numbers can often be ported, subject to eligibility, which LABUSA confirms during setup. Workflow rules beyond that are custom work: LABUSA assesses your requirements first and scopes any automation separately from the fax service.
See the options on our medical practices page, read how eFaaS works, try LABUSA eFaaS free for 30 days, or request a workflow consultation to design your routing with us. You can also contact our team.