Insurance & Authorization
This determines if a patient’s procedure requires prior authorization.
What is the insurance plan/payer requirement?
This tab is used to review insurance coverage in Epic.
What is the Coverage tab?
These codes describe medical procedures and services.
What are CPT codes?
This denial occurs when coverage is inactive.
What is eligibility denial?
This is the first step when speaking with patients.
What is verifying identity?
This type of insurance typically requires referrals for specialists.
What is an HMO?
This activity is used to document pre-access notes.
What is Auth/Cert or Referral?
This type of procedure often requires imaging guidance.
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What is interventional radiology?
This happens when patient info is incorrect.
What is a registration error?
This helps patients understand financial responsibility upfront.
What is providing estimates?
This is the status when an auth has not yet been reviewed by the payer.
What is pending?
This work queue is commonly used to resolve any errors before an account is billed.
What is Claim Edit or Unbilled WQ?
This code type is used to describe diagnoses and supports medical necessity for CPT codes.
What is the diagnosis or ICD-10 code?
This denial is due to missing authorization.
What is authorization denial?
This skill involves listening and responding with understanding.
What is empathy?
This happens when services are performed without required authorization.
What is a denial?
This step ensures all required documentation is attached to a patient's account.
What is completing the checklist?
This CPT code is used for a lumbar puncture performed with fluoroscopic guidance.
What is CPT 62328?
This step helps prevent denials before they occur.
What is pre-access review?
This is used when explaining complex billing issues clearly.
What is simplifying communication?
This is the process of confirming active coverage before services are rendered.
What is eligibility verification?
This error occurs when information does not match between systems.
What is a mismatch/discrepancy error?
This code category includes services like imaging, lab tests, and other non-physician services.
What is HCPCS Level II codes?
This is the financial term for charges not yet billed due to issues.
What are unbilled days?
This approach helps de-escalate upset patients.
What is active listening and reassurance?