Reference
Referral & Prior Auth Gateway glossary
Terms used in Referral & Prior Auth Gateway and its documentation.
Applies to Referral & Prior Auth Gateway as it works today. Moraph updates the platform continuously, and this page is reviewed when it changes.
Terms used in Referral & Prior Auth Gateway and its documentation.
| Term | Meaning |
|---|---|
| Prior authorization | A payer's approval, required before certain services, that the service is covered for the patient. |
| Referral | An order sending a patient for a service, received from the EHR and worked to scheduling. |
| X12 270/271 | The electronic eligibility inquiry and response exchanged with a payer through a clearinghouse. |
| X12 278 | The electronic prior authorization request and response transaction. |
| Payer rules library | The record of which services need authorization from which payer and plan, and what documentation each needs. |
| Pend | A payer holding a request without a decision, usually waiting for more information. |
| Portal hand-off | Preparing a request in full so a specialist can submit it on a payer's own website. |
| Peer-to-peer review | A conversation between the ordering clinician and the payer's reviewer about a denied or pended request. |
| Write-back | Sending authorization status and outcome back into the EHR referral. |
| Clearinghouse | The service that routes electronic transactions between your organization and payers. |
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