Certified Revenue Cycle Representative (CRCR) Practice Exam

What is true of the information provided by a healthcare provider regarding service authorization from the patient's primary payer?

1. It is documented in the patient's medical record

2. It is posted on the remittance advice by the payer

3. It is sent directly to the patient

4. It is filed with the claim submission

The correct answer is: It is posted on the remittance advice by the payer

The information provided by a healthcare provider regarding service authorization from the patient's primary payer is typically found on the remittance advice from the payer. The remittance advice serves as an explanation from the payer to the provider, detailing payments, adjustments, and denials for services rendered. It often includes important information about whether services were authorized, which helps ensure transparency in the billing process and clarifies the reimbursement decisions made by the payer. In contrast, documentation in the patient's medical record usually pertains to the provider's notes and treatment decisions but does not specifically include payer authorization details. While the payer might communicate directly with patients about benefits or claim outcomes, the specific authorization typically remains a provider-payer communication reflected in remittance advice. Filing information with the claim submission also does not apply here, as authorization is a separate process that generally precedes the submission of claims and may not necessarily be included directly in the claim documentation.