Workflow Ready

Patient Confuses EOB with Bill
A fictional caller says the EOB is a bill and asks whether they must pay the displayed amount now. Choose the safest next action, review the explanation, and continue to EOB, ERA, and Payment Basics.
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Payer Call Documentation Practice
A fictional payer representative gives a status, reference number, and follow-up timeframe. Choose the safest next action, review the explanation, and continue to Payer Call Documentation Basics.
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Scheduler Referral Confusion
A fictional scheduler sees a referral document but cannot find an authorization status. Choose the safest next action, review the explanation, and continue to Referral vs Prior Authorization.
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Deductible and Copay Confusion
A fictional benefit response lists both a remaining deductible and a specialist copay. Choose the safest next action, review the explanation, and continue to Deductible, Copay, Coinsurance, and OOP Max.
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Corrected Claim vs Appeal Decision
A fictional processed claim has an incorrect administrative field supported by the approved training record. Choose the safest next action, review the explanation, and continue to Claim Rejection vs Claim Denial.
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Medicare Advantage Verification Scenario
A fictional patient says they have Medicare, but the fictional card shows a Medicare Advantage plan. Choose the safest next action, review the explanation, and continue to Insurance Basics for Beginners.
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Missing Authorization Before Visit
A fictional scheduled service appears to require authorization, but the training tracker has no approved determination. Choose the safest next action, review the explanation, and continue to Prior Authorization Basics.
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Payer Call Documentation Workflow
A structured fictional workflow for preparing, conducting, and documenting a payer call. It usually involves Medical billers, AR follow-up specialists, and prior authorization VAs. and appears during Claim Status, Documentation / Follow-Up.
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Patient Balance Review Basics
A cautious workflow for reviewing a potential patient balance only after payer processing and approved account review. It usually involves Medical billers, receptionists, and authorized patient-balance staff. and appears during Patient Balance / Statement, Documentation / Follow-Up.
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Payer Call Documentation Basics
Prepare, conduct, and document a fictional payer call using facts and approved follow-up steps. This beginner module connects the concept to Claim Status, Documentation / Follow-Up and includes a fictional practice activity.
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