Registration
This is the first document you typically need when registering at a healthcare facility.
What is an ID or insurance card?
This is the term for approval required from an insurance company before a patient receives certain medical services or medications.
What is prior authorization?
If prior authorization is not obtained before a scheduled non-emergency surgery, the insurance company may do this.
What is deny coverage for the procedure?
This city in Minnesota is home to the first and largest Mayo Clinic campus.
What is Rochester?
The Affordable Care Act (ACA) established this online marketplace where individuals can compare and purchase health insurance plans.
What is the Health Insurance Marketplace or Healthcare.gov?
This government program provides health coverage for individuals 65 and older.
What is Medicare?
The healthcare provider must submit this type of request to the insurance company to obtain prior authorization.
What is a prior authorization request form?
Some insurance companies use AI algorithms to approve or deny prior authorization requests. If a request is denied without human review, the provider may challenge the decision by requesting this.
What is a manual review or peer-to-peer review?
Mayo Clinic was founded in the 19th century by this doctor and his two sons.
Who are Dr. William Worrall Mayo and Drs. William James and Charles Horace Mayo?
This major private health insurance company, headquartered in Minnesota, is one of the largest payers in the U.S.
What is UnitedHealthcare?
Before seeing a doctor, new patients are usually required to complete this type of document.
What is a patient intake form?
If a prior authorization request is denied, the provider or patient can submit this to request a second review.
What is an appeal?
When prior authorization is granted, but the patient does not receive the surgery within the approved time frame, the approval may expire. This process is called this.
What is prior authorization lapse or expiration?
The Mayo Clinic evolved from a small medical practice into a world-renowned medical institution after this natural disaster in 1883.
What is the Rochester tornado?
In employer-sponsored health insurance, this term refers to the portion of medical costs an employee is responsible for paying after meeting their deductible.
What is coinsurance?
This form, often signed during registration, gives consent for treatment and acknowledges privacy policies.
What is an informed consent form or HIPAA consent?
Some medications require prior authorization to ensure they are medically necessary and not just a more expensive option. This process is often referred to as this.
What is step therapy?
A surgeon performs a different but related procedure than what was originally approved in the prior authorization. The insurance company may deny payment, citing this issue.
What is a lack of pre-approval for the specific procedure or billing code mismatch?
Mayo Clinic was one of the first medical institutions to adopt this revolutionary medical imaging technique in the 1920s.
What is X-ray technology?
Self-insured employer health plans do not rely on traditional insurance companies but instead use this type of organization to process claims.
What is a Third-Party Administrator (TPA)?
Some insurance plans require you to choose a specific doctor for primary care. This type of plan is called this.
What is an HMO (Health Maintenance Organization)?
Insurance companies may deny prior authorization requests if they find a treatment unnecessary or experimental. The provider can submit additional evidence, often called this, to justify the request.
What is a letter of medical necessity?
Some insurance plans may approve a surgery but only if it is performed at certain facilities or by specific surgeons. This network restriction is known as this.
What is an in-network provider requirement?
The Mayo Clinic has been ranked the #1 hospital in the U.S. by this publication multiple times.
What is U.S. News & World Report?
The federal law that ensures continuous health coverage when transitioning between jobs is known as this.
What is COBRA (Consolidated Omnibus Budget Reconciliation Act)?