Insurance Basics

Topics Covered: insurance basics, patient access insurance workflows, health insurance terminology, patient coverage education, government insurance, commercial insurance, Medicare, Medicaid, Aetna, Cigna, United Healthcare, subscriber, policyholder, dependent, beneficiary, insurance coverage categories, birthday rule, primary insurance determination, dependent child dual coverage, insurance effective dates, coverage dates, provider networks, in-network providers, out-of-network providers, contracted providers, negotiated rates, provider network status, preferred provider tiers, Tier 1 PCP, Tier 2 PCP, complementary provider networks, extended provider networks, national provider networks, network affiliation, payer code selection, insurance plan code selection, organization contract procedures, insurance card interpretation, network information on insurance cards, benefit determination, patient out-of-pocket costs, out-of-network benefit limitations, plan design, HMO plans, PPO plans, EPO plans, POS plans, HDHP plans, high deductible health plans, health savings accounts, HSA, health reimbursement arrangements, HRA, radiology benefit manager, RBM, explanation of benefits, EOB, coverage and benefits, deductibles, co-payments, co-insurance, out-of-pocket maximums, inpatient benefits, emergency room co-payments, primary care office visit benefits, specialty office visit benefits, dermatologist office visit benefits, benefit summaries, insurance company benefit policies, insurance ID cards, payer guides, provider relations assistance, group numbers, group names, employer-sponsored insurance, policy identification numbers, member numbers, enrollee numbers, claim numbers, policy number formatting, policy number suffixes, punctuation in policy numbers, registration system insurance fields, insurance eligibility verification, real time eligibility, HIPAA 270 eligibility inquiry transaction, HIPAA 271 eligibility response transaction, eligible coverage response, ineligible coverage response, subscriber eligibility, dependent eligibility, co-pay information in eligibility responses, co-insurance information in eligibility responses, insurance website verification, automated eligibility verification, third-party eligibility software, batch eligibility transactions, failed eligibility transactions, self-pay conversion, pre-authorization, prior authorization, prior approval, utilization control, cost control, medical appropriateness review, medical necessity requirements, services requiring pre-authorization, emergency services not requiring pre-authorization, payer-specific pre-authorization rules, ordering provider office workflow, hospital pre-authorization team workflow, insurance company authorization review, pre-authorization turnaround time, rescheduling services for pending authorization, pre-authorization numbers, pre-authorization number entry, authorization effective dates, authorization date span, authorization validity period, pre-authorization not guaranteeing coverage, no-authorization denials, write-offs for missing authorization, Notification of Admission, NOA, inpatient admission notification, planned admission notification, unplanned admission notification, payer notification timeframe, 24-48 hour notification window, next-business-day notification, case management collaboration, continued stay authorization, clinical information for additional hospital days, authorized length of stay, denied additional days, patient financial responsibility calculation, eligibility does not equal coverage, accurate insurance information entry, insurance information validation, complete registration information, revenue cycle impact, timely claim payment, claim denials from incorrect insurance information, claim denials from missing authorizations, claim denials from missing notifications, claim resubmission, claim appeals, patient stress from denied claims, patient access role in revenue cycle success, insurance basics knowledge checks, Million Point Challenge review, module assessment, patient access education, insurance basics course content.