INSURANCE BASICS
Amount the patient pays before insurance starts covering services?
What is a deductible
Info confirming client’s mental health visits are covered?
What is benefits verification (VOB)
CPT code for initial diagnostic evaluation in mental health?
What is 90791
Must be obtained before services if required by plan?
What is prior authorization (PA)
Claim was kicked out at the clearinghouse for missing/incorrect info?
What is a claim rejection
The percentage the patient pays after the deductible?
What is coinsurance
This is required to ensure claims are billed to the correct insurance?
What is the payer ID
45-minute psychotherapy session?
What is 90834
Requested after services have already occurred?
What is retro authorization
Frequency code for corrected/ resubmitted claim?
What is Frequency Code 7
Fixed amount patient pays per visit?
What is a copay
When a client chooses to NOT use their insurance and pay privately, this form must be completed and signed?
What is an Insurance Opt-out form
Family session without the identified patient present?
What is 90846
Number of visits approved under authorization?
What are authorized units/ sessions
Denial code for Coordination of Benefits issue?
What is 227
Maximum amount a patient pays in a benefit year before insurance pays 100%?
What is Out of Pocket Maximum
Medicaid plans managed by private insurers in Wisconsin that we accept at GLPG?
What are UBH, Quartz, and BCBS Medicaid
30-minute psychotherapy session?
What is 90832
An insurance company department that handles authorization requests for providers?
What is utilization management
Payment larger than expected causing negative balance?
What is overpayment
Policy type requiring the provider to be in network for coverage?
What is an HMO
Medicare plans that are offered by private insurers?
What is Medicare Advantage
Modifiers used to indicate telehealth services?
What is 95 or GT
For which insurance company do we always request out-of-network authorizations for established clients?
What is HAP
Federal budget rule reducing certain Medicare payments?
What is 253 (Sequestration)