Eligibility Verification
What is the Real-Time Eligibility RTE check
This Athena feature checks patient's insurance status in real time.
What is Health Maintenance Organization
What is Sequence 1
Primary Insurance
What are Patient Account Notes
Internal insurance verification notes belong here.
What is inactive coverage
The patient is no longer active
What is the insurance tab?
This section of the patient chart is used to verify insurance coverage.
This type of plan usually requires an assigned PCP.
What is Sequence 2
Secondary Insurance
These notes may appear on patient statements
What are statement notes
What is "No Response" from Payer?
What are claim rejections or denials?
Verifying eligibility before the visit helps prevent these.
What is Preferred Provider Organization
PPO stands for this.
COB
Staff should never place sensitive internal comments in this section
What are statement notes.
What are mismatched demographics?
What are mismatched demographics
What is eligibility response?
This should be reviewed to determine if coverage is active or inactive.
HMO COVERAGE IS GENERALLY LIMITED TO THESE PROVIDERS
WHAT ARE IN-NETWORK PROVIDERS
If a patient has commercial insurance, and Medicaid what is determined to be sequence 1.
What is commercial insurance?
Notes should be concise, factual, and this
What is professional
Multiple entries for the same insurance can create this problem
What are duplicate insurance entries>
What is 48 hrs?
Eligibility should be verified by Khalia or Nina before the patient's appointment.
What are denials.
Claims may route incorrectly is this is not updated.
What are clean claims and continuity of care
Proper documentation support these.
Incorrect payer selection can result in these
What are claim denials