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Name: __________________________________________ Date: _____________ Score: _____________
Competency Checklist
Procedure 27–1 Verify Insurance Coverage and Eligibility for Services
ABHES Curriculum
MA.A.1.8.c(2) Differentiate managed care; i.e., HMO, PPO, EPO, IPA including referrals and pre-certification
CAAHEP Core Curriculum
VI.P.7 Input patient data utilizing a practice management system
VII.C.5 Identify types of information contained in the patient’s billing record
VII.C.6 Explain patient financial obligations for services rendered
VII.P.4 Inform a patient of financial obligations for services rendered
VII.A.1 Demonstrate professionalism when discussing patient’s billing record
VII.A 2 Display sensitivity when requesting payment for services rendered
VIII.C.1 Identify: (a) types of third party plans, (b) information required to file a third party claim, and (c) the
steps for filing a third party claim
VIII.C.2 Outline managed care requirements for patient referral
VIII.C.3 Describe processes for: (a) verification of eligibility for services, (b) precertification, and (c)
preauthorization
VIII.P.1 Interpret information on an insurance card
VIII.P.2 Verify eligibility for services including documentation
VIII.A.1 Interact professionally with third party representatives
VIII.A.3 Show sensitivity when communicating with patients regarding third party requirements
Task: Interpret information on a patient’s insurance card and verify the patient’s insurance coverage
and accurate billing information prior to rendering service to prevent claim rejection due to
patient ineligibility for coverage.
Supplies & Conditions: Computer, patient insurance identification card, insurance website address, individual password
for access on website, and telephone.
Standards: A maximum of three attempts may be used to complete the task. The time limit for each attempt
is 15 minutes, with a minimum score of 70 percent. Scoring: Determine student’s score by
dividing points awarded by total points possible and multiplying results by 100.
EVALUATION
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