Verify First
Name the three-step escalation ladder for verifying a client's benefits, in order.
What is Sohar first, then a portal check, then an IA call as a last resort?
Unless the SOP names an exception, this is the portal for all BCBS, Blue plans, and Anthem.
What is Availity?
Spell out "MO" and say what it does.
What is a manual override — a tool used to change a client's insurance eligibility details manually?
The call you make when you have ERA data and need to check if they were processed correctly.
What is a Claims IA Call?
How long after a provider confirms a session does Headway submit the claim?
What is 48 hours? (The grace period lets the provider edit session details first.)
When a Sohar lookup returns successfully, it is the source of truth for these.
What are benefit values (copay, coinsurance, deductible)?
Log in to this portal and you're really looking at Cigna.
What is Evernorth?
Often you don't need an MO at all — try this first.
What is refreshing the insurance lookup (and correcting the client's info)?
Check this app in the Zendesk sidebar before you submit a call request.
What is Duplicate IA Call Detection?
Headway receives one of these from the payer; the client receives the other.
What are an ERA (Headway) and an EOB (client)?
Sohar will happily hand you a copay — but it can never tell you this one thing.
What is whether the plan is in-network or out-of-network? ⚠️ Network status is determined internally by Headway; the Atlas lookup is most accurate, and an IA call is the ultimate source of truth.
On an Availity patient card, green, red, and orange mean these three things.
What are active coverage, inactive coverage, and a request error (recheck the info)?
A client is fully covered with no cost share. This is what you enter for copay and coinsurance.
What is 0 for both? ⚠️ Never leave MO fields blank.
The client disputes their benefits, but Sohar and Atlas agree with each other. What's your move?
What is do not request an IA call — proceed to a portal check only if the customer continues to dispute?
Headway's Timely Filing rule — the window a provider has to confirm a session.
What is 30 days?
Before you trigger or trust any lookup, confirm these three client fields are entered correctly.
What are name, date of birth, and member ID?
You found a deductible listed in the portal. It does not automatically mean this.
What is that the deductible applies to mental health benefits?
The member ID in Atlas has a typo. Never do this before fixing it.
What is perform a manual override?
Coverage for these three CPT codes always requires manual verification via an IA call — with a BCBSTX exception.
What are 90846, 90847, and 90853 (family, couples, and group therapy)?
This CPT code is the psychiatric diagnostic evaluation, and it can only be billed once every six months — no exceptions.
What is 90791?
What is, open Atlas, verify with Sohar, confirm in the portal, check claims data, check the duplicate IA call detection app.
The insurance portal agrees with Sohar, tell me your next step.
What is MO Atlas to match Sohar. MO to Active if Sohar is Active; MO to Inactive if Sohar is Inactive.
Uncheck this box during an MO and you'll overwrite the patient's fields with the subscriber's data — and likely cause a claim denial.
What is "Patient Is A Dependent"?
A client writes that their insurance carrier has not received claims, but you’ve confirmed that Headway has sent them at least 1 week ago. Tell me the prerequisite to your next step.
What is you’ve confirmed that Headway has sent the claims at least 1 week ago, and the claims dashboard/Atlas indicates a carrier-generated claim number (see Payer_claim_id in claims dashboard, control number at the appointment-level Atlas claims tab).
Reprocessing vs. resubmitting: which one is the payer's job, and how do we ask for it?
What is reprocessing — a payer error, requested via a claims IA call? (Resubmitting is Headway-side, via an Ops Jira ticket.)