Insurance
Patient
The person receiving or seeking healthcare services. A common beginner confusion: Patient, subscriber, and guarantor can be different people.
Payer
An organization that processes benefit and claim responsibility under a health plan or program. A common beginner confusion: Payer, plan, network, and employer are related concepts but not interchangeable.
Eligibility
A status indicating whether coverage appears active for a person and relevant date under a plan response. A common beginner confusion: Active eligibility is not a guarantee of coverage or payment.
New Patient Intake Workflow
A safe administrative sequence for receiving and checking new-patient information through approved systems. It usually involves Medical VAs, schedulers, and receptionists. and appears during Patient Intake.
Insurance Eligibility Verification Workflow
A fictional workflow for confirming plan identity and eligibility status for the relevant date. It usually involves Medical VAs, schedulers, receptionists, and medical billers. and appears during Insurance Verification.
US Healthcare Basics: Patient, Provider, Payer
Explain the three central participants and how information and responsibility move between them. This beginner module connects the concept to Patient Inquiry, Insurance Verification and includes a fictional practice activity.
Insurance Basics for Beginners
Recognize common plan information and know what must still be verified. This beginner module connects the concept to Patient Intake, Insurance Verification and includes a fictional practice activity.
New Patient Intake Basics
Understand the intake sequence and use only approved systems and minimum necessary information. This beginner module connects the concept to Patient Intake and includes a fictional practice activity.
Eligibility and Benefits Basics
Separate eligibility status from benefit detail and document the source and date. This beginner module connects the concept to Insurance Verification, Benefits Check and includes a fictional practice activity.