Medical Billing Terms A: Benefits Assignment, Authorizations and Audits

Benefits assignment (assignment of benefits) is the first term on this page, which finishes medical billing terms A, with A/R follow-up, authorization terms, audits, and the portals billers use every week. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms A: Benefits Assignment - MCM South Medical Billing Service, LLC

Glossary pages

0-9AB C D E F G H I J K-L M N-O P Q-R S T U-V W-Z

Pages in A

A-1 A-2A-3

On this page (21 terms)

Appeal Success Rate
Application Programming Interface (API)
Applied Behavior Analysis (ABA)
A/R Aging
A/R Follow-Up
Assignment (Medicare)
Assignment of Benefits (AOB)
Associate Licensed Clinician
athenahealth
Attestation
Audio-Only Telehealth
Audit
Audit Trail
Authorization Date Range
Authorization Denial
Authorization Number
Authorization Request
Authorization to Access CAQH
Authorized Units
Automation
Availity

How to use these Benefits Assignment definitions

Use this page as a quick reference for Assignment of Benefits, from Appeal Success Rate to Availity. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Assignment of Benefits details with the payer before you bill.

Checklist: put the benefits assignment definitions to work

Check the benefits assignment entries above before you send a claim that depends on them.
Share this benefits assignment page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions benefits assignment, find the matching entry and note the date you checked it.
Keep your benefits assignment notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies benefits assignment before you change a workflow.
Train new staff on benefits assignment first, then move on to the rest of the glossary.
Log any benefits assignment question that comes up twice, then add the answer to your billing procedures.
Use the source links under the benefits assignment entries to confirm the current rule.
Print the benefits assignment entries you use most and keep them at the billing desk.
Review your benefits assignment notes each quarter, because payer and CMS rules change.
Mark where benefits assignment work differently for psychotherapists and for psychiatrists in your own procedures.

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Appeal Success Rate

General (all payers)

Also called overturn rate; appeal overturn rate

Definition: The percentage of appealed claims that are reversed in the provider's favor.
Why it matters: Shows whether appeal effort is paying off.
Illustrative example: A practice wins 60% of its medical necessity appeals.

Related termsAppeal Denial Rate

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics Denials & Appeals

Application Programming Interface (API)

General (all payers)

Also called API; EHR API; payer API

Definition: A set of rules that lets software systems exchange data automatically.
Why it matters: APIs power real-time eligibility, authorization, and record exchange.
Illustrative example: An EHR sends eligibility requests to a payer through an API.

Related termsFHIR Interoperability

Reference sourceHL7 International HL7 FHIRchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms EDI & Clearinghouse Terms

Applied Behavior Analysis (ABA)

General (all payers)

Also called ABA; ABA billing

Definition: A therapy approach often used for autism, billed with specific CPT codes and requiring authorization and specific credentials in many plans.
Why it matters: Distinct coverage, authorization, and credential rules apply.
Illustrative example: A payer authorizes ABA hours with a treatment plan.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesBehavioral Health Specific Terms

A/R Aging

General (all payers)

Also called aging report; A/R aging buckets; 0-30 31-60 61-90 90+

Definition: A report that groups unpaid claims by how long they have been outstanding, typically in 30-day buckets.
Why it matters: Older buckets are harder to collect and show where follow-up is needed.
Illustrative example: A biller works the 61 to 90 day bucket weekly.

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

A/R Follow-Up

General (all payers)

Also called accounts receivable follow-up; claim follow-up; follow-up

Definition: The routine work of checking unpaid claims, contacting payers, and resolving problems until claims are paid or closed.
Why it matters: Regular follow-up is how unpaid claims are caught before timely filing runs out.
Illustrative example: A biller works claims older than 30 days by payer every week.

Related termsA/R Aging Claim Status Timely Filing

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics Claims Processing

Assignment (Medicare)

Medicare

Also called accept assignment; Medicare assignment; participating provider assignment

Definition: In Medicare, accepting assignment means a provider agrees to accept the Medicare-approved amount as payment in full for a covered service. The patient is then responsible only for the deductible and coinsurance.
Why it matters: Providers that accept assignment on all claims are participating providers. Others are non-participating and may be subject to a limiting charge. Assignment on a Medicare claim is a different concept from a private-plan assignment of benefits.
Illustrative example: A participating clinical social worker accepts assignment and collects only the 20 percent coinsurance from the patient.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Payment & Reimbursement

Assignment of Benefits (AOB)

General (all payers)

Also called AOB; assignment of insurance benefits; direct payment authorization

Definition: An assignment of benefits is a patient's signed authorization that lets the insurer pay the provider directly instead of paying the patient.
Why it matters: Without an assignment, a payer may send the payment to the patient. Get the signed form at intake and show it on the claim in Box 13. Medicare uses a different assignment concept, described under Assignment (Medicare).
Illustrative example: A patient signs the AOB at intake so the plan pays the practice directly.

Reference sourceNUCC, 1500 Claim Form Reference Instruction Manual, Version 13.0 (7/25)checked 10/9/26

CategoriesPayment & Reimbursement Audits & Compliance

Associate Licensed Clinician

General (all payers)

Also called pre-licensed clinician; associate-level therapist; intern billing

Definition: A clinician who has completed a degree but is not yet fully licensed and practices under supervision toward full licensure.
Why it matters: Many payers will not credential associates or require billing under a supervisor, which shapes revenue and staffing.
Illustrative example: A payer does not credential associates, so the group bills under a supervisor when policy allows.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesCredentialing & Enrollment Behavioral Health Specific Terms

athenahealth

General (all payers)

Also called athenaOne; athena EHR

Definition: A vendor of EHR, practice management, and revenue cycle services for medical practices. Listed for reference; not an endorsement or partnership.
Why it matters: Used by some multispecialty and behavioral health practices.
Illustrative example: A practice uses athenahealth for billing.

Reference sourceathenahealthchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Attestation

General (all payers)

Also called CAQH attestation; profile attestation

Definition: The provider's confirmation that the data in their credentialing profile is accurate and current. Payers use it to trigger and support credentialing decisions.
Why it matters: An expired attestation can freeze credentialing and put network status at risk.
Illustrative example: A therapist re-attests in CAQH ProView after updating a new practice address.

Reference sourceDataSpring (formerly CAQH)checked 10/9/26

CategoriesCredentialing & Enrollment Provider Data Management Terms

Audio-Only Telehealth

General (all payers)

Also called telephone therapy; audio-only visit

Definition: A telehealth service delivered through audio without video, covered in some situations by some payers.
Why it matters: Coverage, modifiers, and POS rules differ and have changed.
Illustrative example: A patient without video access completes a session by phone under a payer's audio-only policy.

Related termsModifier 93 Modifier FQ Telehealth

Reference sourceCMS (Centers for Medicare & Medicaid Services)HHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesTelehealth Terms

Audit

General (all payers)

Also called payer audit; billing audit

Definition: A formal review of claims and documentation to check billing accuracy and compliance.
Why it matters: Audits can lead to recoupments, corrective plans, and referrals.
Illustrative example: A payer requests records for a sample of claims.

Reference sourceHHS Office of Inspector General (OIG)CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance

Audit Trail

General (all payers)

Also called audit log; access log

Definition: A record of who accessed or changed data and when, used for security and compliance.
Why it matters: Required for security and helps investigate issues.
Illustrative example: An EHR logs who viewed a chart.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAI & Healthcare Automation Terms Audits & Compliance

Authorization Date Range

General (all payers)

Also called auth span; approved dates

Definition: The start and end dates for which an authorization is valid.
Why it matters: Services outside the span deny.
Illustrative example: A session occurs after the authorization ended.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPrior Authorization Terminology

Authorization Denial

General (all payers)

Also called no authorization denial; missing auth denial

Definition: A denial because a required prior authorization was missing, invalid, or did not match the service.
Why it matters: Often not fixable after the fact, so it must be prevented.
Illustrative example: A claim denies because the units exceeded the authorization.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals Prior Authorization Terminology

Authorization Number

General (all payers)

Also called auth number; reference number

Definition: The identifier a payer assigns to an approved authorization, often required on the claim.
Why it matters: A missing or wrong number causes denials.
Illustrative example: The claim lists the auth number in the prior authorization field.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPrior Authorization Terminology Claims Processing

Authorization Request

General (all payers)

Also called auth request; precert request

Definition: A submission to a payer asking for approval, with clinical information and requested services.
Why it matters: Complete, specific requests reduce denials and delays.
Illustrative example: A biller submits diagnosis, codes, dates, and notes with the request.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPrior Authorization Terminology

Authorization to Access CAQH

General (all payers)

Also called CAQH authorization; profile authorization

Definition: The provider's permission, set inside ProView, that lets a named payer view the provider's CAQH profile.
Why it matters: Without it, the payer sees a blank profile and the application stalls.
Illustrative example: A practice adds each payer's name to the 'Authorize' list in ProView.

Reference sourceDataSpring (formerly CAQH)checked 10/9/26

CategoriesCredentialing & Enrollment Provider Data Management Terms

Authorized Units

General (all payers)

Also called approved visits; authorized sessions

Definition: The number of visits, units, or days a payer approved under an authorization.
Why it matters: Billing beyond authorized units leads to denials.
Illustrative example: An authorization covers 8 sessions from a start date to an end date.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPrior Authorization Terminology

Automation

General (all payers)

Also called healthcare automation; workflow automation

Definition: Using software to perform routine tasks with little manual effort.
Why it matters: Frees staff for exceptions.
Illustrative example: A system auto-posts ERAs.

Reference sourceHFMAchecked 10/9/26

CategoriesAI & Healthcare Automation Terms Revenue Cycle Metrics

Availity

General (all payers)

Also called Availity Essentials; Availity portal

Definition: A health information network and portal used by many payers for eligibility, claims status, authorizations, and other transactions, and a clearinghouse. Listed for reference; not an endorsement or partnership.
Why it matters: Many payers direct providers to Availity for portal functions.
Illustrative example: A biller checks a member's eligibility and claim status through Availity.

Reference sourceAvailitychecked 10/9/26

CategoriesEDI & Clearinghouse Terms

Quick answer: Benefits Assignment

What is assignment of benefits in medical billing?

It is a patient's signed authorization that lets the insurer pay the provider directly instead of paying the patient. Get the form at intake and show it in Box 13 of the claim.

Frequently asked questions: Benefits Assignment

What is an assignment of benefits?

It is a patient's signed authorization that lets the insurer pay the provider directly. It shows on the claim in Box 13.

What is the difference between A/R aging and A/R follow-up?

A/R aging is the report that groups unpaid claims by age. A/R follow-up is the work of contacting payers and resolving those claims.

Why do claims deny for authorization problems?

A claim can deny when the authorization is missing, expired, or does not match the service, dates, or units. Check the authorization number, date range, and authorized units before you bill.

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Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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