Referral / Authorization
Prior Authorization
Recognize, track, and escalate authorization requirements without promising approval or payment. Connect this lesson to Referral / Authorization and complete a fictional practice before continuing.
Prior Authorization Workflow Infographic
Follow requirement verification, submission, tracking, determination, and documented next action. Designed for visual learners and connected to the Referral / Authorization stage.
Referral vs Prior Authorization Infographic
Compare who initiates each item, what it may support, and why both requirements must be verified. Designed for visual learners and connected to the Referral / Authorization stage.
Scheduler
A front-desk role focused on identifying appointment needs, using approved appointment types, confirming administrative requirements, and documenting handoffs. This guide maps the first lessons, workflows, tools, templates, and truthful skill evidence a beginner can prepare.
Prior Authorization VA
A pre-service administrative role that checks stated requirements, coordinates approved information, tracks requests, documents status, and escalates barriers. This guide maps the first lessons, workflows, tools, templates, and truthful skill evidence a beginner can prepare.
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.
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.
Referral
A direction or request from an authorized provider for a patient to see another provider or receive a service, depending on plan and workflow rules. A common beginner confusion: Referral and prior authorization are not interchangeable.
Prior Authorization
A payer review process that may be required before certain services under current plan rules. A common beginner confusion: Authorization does not replace eligibility, benefits, medical-necessity, claim, or employer requirements.
Prior Authorization Tracking Workflow
A status-tracking workflow for stated authorization requirements, submissions, responses, and next actions. It usually involves Prior authorization VAs and Medical VAs. and appears during Referral / Authorization, Documentation / Follow-Up.