Insurance Basic
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
What is insurance verification?
A set fee agreed on by the payer and hospital
What is a contracted rate?
The most important tone to use with patients
What is empathy?
The department that sets patients up for success
What is Pre‑Access?
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?
The portion the patient pays at time of service
What is a copay?
This confirms you understand the patient’s concern
What is active listening?
A key word patients want when calling us
What is clarity?
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 estimate explains expected patient charges
What is a patient estimate?
A call that ends with clear next steps
What is resolution?
What Pre‑Access protects the organization from
What are denials?
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?
When a claim is fully paid with no patient balance
What is paid in full?
This should always be documented after a call
What are notes?
What accuracy + compassion create
What is trust?
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?
This can cause patient frustration if not explained clearly
What is unexpected balance / surprise billing?
Staying calm when speaking with an upset patient
What is de‑escalation?
Pre‑Access professionals are the _____ of revenue cycle
What is the front door?