Guide

Patient-Provider-Payer Triangle
A beginner guide to the relationship among the patient, healthcare provider, and payer. It is designed for Medical VA, Medical Biller, Scheduler, Receptionist learners and connects to the Patient Inquiry and Insurance Verification stage. Use fictional data only when practicing.
Open
Referral vs Authorization Guide
A plain-English comparison of referrals and prior authorizations, including why requirements must be verified. It is designed for Medical VA, Scheduler, Prior Authorization VA learners and connects to the Referral / Authorization stage. Use fictional data only when practicing.
Open
Claim Rejection vs Denial Guide
A workflow-based explanation of a front-end rejection versus a processed denial. It is designed for Medical Biller, AR Follow-Up Specialist learners and connects to the Claim Submission and Denial / Rejection Review stage. Use fictional data only when practicing.
Open
Patient Responsibility Basics Sheet
A beginner reference for deductible, copay, coinsurance, non-covered amounts, and remaining responsibility. It is designed for Medical VA, Medical Biller, Receptionist learners and connects to the Benefits Check and Patient Balance / Statement stage. Use fictional data only when practicing.
Open

Patient-Provider-Payer Triangle