Revenue Cycle 101: Determining Insurance Order

Article Overview

This article explains the general topic of insurance order determination within revenue cycle workflows, focusing on common coverage scenarios that billing and office staff encounter. It is intended for healthcare administrators, revenue cycle teams, and medical office personnel who need a high-level understanding of how multiple insurance plans are typically prioritized. The article covers Medicare, Medicare replacement and Medicare Advantage plans, employer-sponsored group coverage, coverage for minor children, and Medicaid as a payer of last resort, along with a brief note about common real-world exceptions and patient responsibility for understanding coverage.