> ## Documentation Index
> Fetch the complete documentation index at: https://docs.patient-experience.commure.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Accepting and declining

> Make a decision on a referral and trigger writeback to external systems.

After reviewing a referral, you make a final decision: **Accept** or **Decline**. This triggers automatic writeback to HCHB (chart), insurance systems, and the patient portal.

## Making a decision

<Steps>
  <Step title="Open the referral">
    Navigate to the referral detail view from the queue. Confirm all patient data, diagnoses, and insurance information are correct before proceeding.
  </Step>

  <Step title="Select Accept or Decline">
    Use the **Accept** or **Decline** button in the detail view header.

    * **Accept** — The referral is approved for service.
    * **Decline** — You will be prompted to select a non-admit reason before the decision is finalized.
  </Step>

  <Step title="Confirm the action">
    A confirmation dialog appears. Review the summary and confirm.
  </Step>

  <Step title="Monitor writeback">
    After confirmation, writeback begins. The referral status changes to **In Progress** and a progress indicator appears. The status updates in real time as each system completes.
  </Step>
</Steps>

## Non-admit reason (decline only)

When declining a referral, you must select a non-admit reason from the dropdown. This is required before the decline can be submitted.

<Warning>
  Declining a referral is a significant action. Confirm the non-admit reason is accurate — it is written back to HCHB and may affect reporting.
</Warning>

## Writeback progress

After a decision, writeback runs against three systems independently:

| System             | Description                                      |
| ------------------ | ------------------------------------------------ |
| **Chart (HCHB)**   | Patient and clinical data written to the EHR.    |
| **Insurance**      | Insurance and eligibility data submitted.        |
| **Patient portal** | Patient record created or updated in the portal. |

Each system has its own sub-status (Pending → Processing → Complete or Error). You can view these in the detail view after the decision is made.

## What to do if writeback fails

If one or more systems shows an **Error** sub-status:

1. Note which system failed (chart, insurance, or portal).
2. Contact your administrator — they can rerun writeback for the failed system from the admin tools.
3. If partial writeback is stuck, an admin can manually complete the sub-status after verifying the data was written externally.

<Info>
  The referral does not return to a pending state after a writeback error. The decision stands; only the writeback needs to be resolved.
</Info>

## Approve vs. accept

The workflow has two steps for positive outcomes:

* **Approve** — An initial approval before the full accept workflow. Used when a second review or sign-off is required.
* **Accept** — The final acceptance that triggers writeback.

Not all referrals require an explicit approve step before accept. Your workflow depends on your organization's configuration.