instructions: select the most appropriate response.\nwhich must usually be received from a payer before…

instructions: select the most appropriate response.\nwhich must usually be received from a payer before treatment by a specialist will be covered?\n○ a. explanation of benefits\n○ b. remittance advice\n○ c. sanction\n○ d. prior approval

instructions: select the most appropriate response.\nwhich must usually be received from a payer before treatment by a specialist will be covered?\n○ a. explanation of benefits\n○ b. remittance advice\n○ c. sanction\n○ d. prior approval

Answer

Brief Explanations:

  • Explanation of benefits (EOB): It is a statement sent after a claim is processed, not before treatment.
  • Remittance advice: It details payment for services already provided, not for pre - treatment coverage.
  • Sanction: This term is not related to the process of getting treatment coverage from a payer.
  • Prior approval (or prior authorization): Insurance companies often require this from the payer (e.g., the insurance - holding patient or their representative) before covering specialist treatment. It is a common practice to ensure the treatment is medically necessary and covered under the insurance plan.

Answer:

d. prior approval