INSURANCE BASICS
This is proof of coverage that includes member ID and payer info
What is an insurance card?
This step confirms coverage before the patient is seen
This step confirms coverage before the patient is seen
The document requested no matter how many times you already sent it.
What is clinical notes?
The department that sets patients up for success
What is Pre‑Access?
This is what you ask for when the provider sends everything except what you need.
What is MISSING CLINICAL (AGAIN!!!)
This determines if a service is IN or OUT of network
What is network status?
This is required for certain procedures to ensure coverage
What is prior authorization?
This form is “required” but somehow never the correct version.
What is the authorization letter.
A key word patients want when calling us
What is clarity?
The authorization status that means “check back in 3–5 business lifetimes.”
What is pending?
The amount the patient must pay before insurance kicks in
What is a deductible?
The team responsible for collecting patient responsibility upfront
What is pre‑access?
This happens when the provider handwriting becomes a new language.
What is denial by interpretation?
What Pre‑Access protects the organization from
What are denials?
This magical word instantly makes any denial… still a denial.
What is urgent?
A plan that usually requires a PCP referral
What is an HMO?
This helps prevent denials before the visit
What is medical necessity or auth review?
The real reason auths get delayed—hint: it’s not the review time.
What is missing information?
What accuracy + compassion create
What is trust?
The moment when the auth finally approves—right after the patient no longer needs the service.
What is “perfect timing”?
The term when insurance pays less because services were out of network
What is reduced benefit / penalty?
The process of confirming CPT codes match the scheduled service
What is review/validation?
WHAT IS "PEER TO PEER".
Pre‑Access professionals are the _____ of revenue cycle
What is the front door?
This is what you silently scream when the CPT code changes after submission.
What is WHY?!