Authorization
An insurance providing official permission or approval for a procedure to completed.
What is an authorization?
A primary care physician permits the patient to another physician for care, typically a specialist.
What is a referral?
A standardized 5 digit medical code used to report procedures, test, and services performed
What is a CPT code?
Diagnosis code, CPT code, patient demographics (name, member ID #, date of birth), proposed date of service.
What information you need to submit a prior authorization?
Group of doctors, hospitals and health care providers that provide coordinated care to patients
What is an ACO?
A standard set of letters and numbers used by doctors to name a patient's disease, injury, or symptom
What is a diagnosis code?
Unique identification number issued by insurer with regard to the procedure
What is a prior authorization number?
A joint federal and state program that provides free or low-cost health coverage to peole with limited income and resources.
What is Medicaid?
What is an HMO?
Unique code assigned to a specific phone call, customer support interaction.
What is a call reference number?
Insurance typically for individuals 65+, however individuals can be eligible based on disability and/or end stage renal disease.
What is Medicare?
Flexible type of health insurance plan where referral is NOT required.
What is a PPO?
Notification to an insurance when a patient is admitted for a scheduled procedure
What is an NOA?
Medical treatment that requires an official admission and at least one overnight stay in a hospital
What is inpatient?
This should always be verified before checking authorization requirements.
What is insurance coverage eligibility?