Prior Authorization and Eligibility study kit
Cheatsheet, term cards, never-miss list, and a seven-day plan. Original study material.
The rule
A thin packet is a gather step. Submit or route a complete packet. This desk does not approve or deny.
If a named finding is missing, request that finding. If the portal is down, use the backup channel and timestamp it.
Never miss
- Not every service is gated.
- Covered and authorized are different.
- CMS publishes expedited and standard clocks for impacted payers. Confirm the current rule.
- Proprietary criteria products are named only as concepts.
Traps
- Approving to keep turnaround pretty.
- Copying another patient's imaging.
- Promising claim payment from an authorization.
Shortcuts
- Member, provider, service, then clinicals.
- Expedited is a definition.
- Note: reviewed, missing, next owner.
Memory hooks
- GATHER-OR-REFER. Never invent, never refuse coverage from this desk Thin chart rule.
This is a practice drill for the desk.
- Day 1Scope and safe next stepRead the Scope and safe next step terms, then the never-miss lines that touch this domain.
- Day 2Packet and evidenceRead the Packet and evidence terms, then the never-miss lines that touch this domain.
- Day 3Routing, clocks, and follow-throughRead the Routing, clocks, and follow-through terms, then the never-miss lines that touch this domain.
- Day 4Scope and safe next stepRead the Scope and safe next step terms, then the never-miss lines that touch this domain.
- Day 5Packet and evidenceRead the Packet and evidence terms, then the never-miss lines that touch this domain.
- Day 6Mixed recallRun the term cards, then a short drill. Restate the one-line rule out loud.
- Day 7Full drillSit the 9-question exam and review every miss against this kit.