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3.4 Verifying Patient Eligibility for Insurance Benefits, 3.5 Determining Preauthorization and Referral Requirements, 3.6 Determining the Primary Insurance Study Guide$9.99
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3.4 Verifying Patient Eligibility for Insurance Benefits, 3.5 Determining Preauthorization and Referral Requirements, 3.6 Determining the Primary Insurance Study Guide
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3.4 Verifying Patient Eligibility for Insurance
Institution
3.4 Verifying Patient Eligibility For Insurance
3.4 Verifying Patient Eligibility for
Insurance Benefits, 3.5 Determining
Preauthorization and Referral
Requirements, 3.6 Determining the
Primary Insurance Study Guide
Establish financial responsibility before - Answer-an encounter (except in emergency)
Verify financial responsibility for - A...
3.4 Verifying Patient Eligibility for
Insurance Benefits, 3.5 Determining
Preauthorization and Referral
Requirements, 3.6 Determining the
Primary Insurance Study Guide
Establish financial responsibility before - Answer✔✔-an encounter (except in emergency)
Verify financial responsibility for - Answer✔✔-benefits from the patient information form (PIF)
and insurance card.
Contact the payer to verify: 1. - Answer✔✔-Patient's eligibility for benefits
Contact the payer to verify: The amount of the copayment or coinsurance required at the time
of - Answer✔✔-service
Contact the payer to verify: 3. Whether the planned encounter is for a covered service
considered medically necessary under - Answer✔✔-the payer's rules
Determine preauthorization and - Answer✔✔-referral requirements
Determine the primary payer if more than - Answer✔✔-one insurance plan is in effect
Check out-of-network benefits if the practice does not participate with the - Answer✔✔-
insurance plan presented by the patient
Verify amounts for copayment and coinsurance because these could have - Answer✔✔-changed
over time
If the service will not be covered, inform the patient of his or her - Answer✔✔-financial
responsibility in advance
HIPAA Eligibility for a Health Plan - Answer✔✔-electronic transaction in which a provider asks
for and receives an answer about a patients eligibility for benefits (X12 270/271)
Trace number - Answer✔✔-number assigned to a HIPAA 270 electronic transaction
Advance beneficiary notice (ABN) - Answer✔✔-Medicare financial agreement form, signed by
the patient, that proves you have informed the patient of his or her financial responsibility for a
service not covered by benefits
Preauthorization is requested before a patient is given - Answer✔✔-certain types of medical
care
Prior authorization number (Certification number) - Answer✔✔-identifying code assigned when
preauthorization is required
HIPAA Referral Certification and Authorization - Answer✔✔-transaction in which a provider asks
for a health plan for approval of a service and gets a response (X12 278)
Referral number - Answer✔✔-authorization number given to the referred physician
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