Enter your name as Last Name, First Name, Middle Name (if any) before selecting a case. Your name will remain with your work and will appear in the completed case-summary PDF and filename.
PA
Patient Access Simulation Lab
Integrated Patient Access Training Platform
Practice a complete mock patient call, post-call insurance verification, and guided prior authorization workflow.
Fictional training environment
LearnerNot entered
Fictional training environment. All patients, providers, payers, phone numbers, portal addresses, email addresses, schedules, and medical records are fictional. Do not enter real patient information.
Completed sample — learner reference
This case is already completed and is read-only. Use the sidebar to review the finished intake, scheduling, insurance verification, prior-authorization packet, and case summary. The CPT/HCPCS authorization lookup remains interactive so you can practice searching additional codes.
Case Brief
1
Incoming Mock Patient Call
The facilitator will act as the patient and provide the case information verbally. Do not use hidden scenario answers or assume details that were not stated.
Student Assignment
Training Objective
Gather accurate patient and insurance information, schedule the correct appointment, close the patient call appropriately, verify coverage with the payer, and complete any required authorization work.
Clinic Reference
Fictional
Multi-Specialty Provider Directory
Use the patient’s reason for visit to select the correct specialty and provider.
Patient Intake and Registration
Mock patient call
☎
Patient Call in Progress
Ask the facilitator-patient for each item and type the answer into the appropriate field. The form starts blank by design.
Patient Demographics
Insurance Information from Patient
Capture exactly what appears on the insurance card or what the patient provides. Coverage is not yet verified.
Appointment Intake
Appointment Scheduling
☎
Patient Call Continues
Use the provider reference and schedule to offer realistic appointment options. Document the patient’s selection and any preparation instructions.
Patient Availability
Offer at least two reasonable options when possible, then record the patient’s selection.
Provider Calendar
Select a date to view the doctor's schedule. Gray dates are unavailable or clinic-closed.
AvailabilityLimitedUnavailable
Doctor's Schedule
Select a date
No date selected
Options Offered to Patient
Scheduling & Intake Audit
Validate the information captured during the mock call before closing this phase. Incorrect answers are not displayed.
Required
Finish the appointment workflow, then select Review & Validate Intake. Every required item must match the assigned case before Insurance Verification can unlock.
Patient Call Closing
Not completed
Insurance Eligibility and Benefits Verification
Service specific
2
Post-Call Insurance Verification
The patient call is complete. Use only the registration and insurance information captured during that call to verify the member and obtain service-specific benefits.
Verification Service
The office visit and downstream service may have different benefit and authorization requirements.
Select a Verification Method
Verify by calling Provider Services or by using the payer website. Both paths require successful patient and member verification before benefit information is released.
Eligibility Payer Representative
Ask the representative for each category, then enter the information in the verification worksheet.
ABC Insurance Provider Portal
Eligibility and benefits inquiry · Training website
Access required
Before accessing eligibility: obtain and enter the patient's full name, rendering provider's name and NPI, clinic Tax ID, member ID, patient date of birth, and scheduled date of service.
Verification Worksheet
Prior Authorization Workflow
Review required
3
Guided Prior Authorization Inquiry
This is no longer a facilitator-led mock call. Select the questions you need to ask, and the simulated payer representative will provide a case-specific verbatim response.
Agent Decision Point
Confirm whether authorization is required for the exact code and service before submitting records.
Prior Authorization Questions
Post-Call Medical Records Activity
Current patient only
Retrieve the Current Patient’s Medical Records
The payer conversation has ended. Open the fictional EHR for the patient currently selected, download the available records, check signatures and completeness, and decide whether a clinic request is needed.
Only records for the patient currently pulled up are shown. Download and review each available PDF before attaching it to the authorization packet.
Authorization Submission
Choose accepted channel
Case Completion
Submission summary
Action Timeline
Scheduling Simulation Mock-Call Script Guide
Field-by-field prompts for the learner-led Scheduling & Intake conversation
Use this as a professional framework, not a rigid recital. Ask one clear question at a time, listen fully, document the response, and read back names, dates, phone numbers, emails, and identifiers when accuracy matters.
Accuracy rule: Structured facts must be entered exactly as the facilitator-patient provides them. Reason for visit, clinical context, referral source, preferred days/times, and the actual appointment may be captured naturally as long as the meaning is preserved and the booked slot is valid.
Privacy and scope: Use only fictional training data. Do not diagnose, give medical advice, or promise coverage, payment, authorization, or a clinical outcome.
1. Open the Patient Call and Verify Identity
Opening: “Thank you for calling the [Clinic Name]. My name is [your name]. How can I assist you today?”
Patient name
“Can I have your full legal name, please?” “Can you spell your last and first names for me?”
Enter Last Name, First Name, Middle Name (if any).
Date of birth
“What is your date of birth, including the year?”
Select the exact date and read it back.
Gender
“What gender should we record in your registration?”
Select the response provided.
MRN / New patient
“Have you been seen at this clinic before, or is this your first visit?” “Do you have your medical record number?”
Enter the MRN, or select New Patient when no MRN exists.
Identity read-back: “I have your name as [Last, First, Middle if any] and your date of birth as [date of birth]. Is that correct?”
2. Capture Contact and Address Information
Primary phone
“What is the best phone number to reach you?”
Capture and confirm all digits.
Email
“What email address would you like us to use? Please spell it slowly.”
Enter the complete address and confirm spelling.
Preferred contact
“How would you prefer that the clinic contact you?”
Select the stated method.
Preferred language
“What language do you prefer for healthcare communication?”
Select the stated language.
Street address
“What is your current street address?”
Include number, street, and unit when applicable.
City / State / ZIP
“What city, state, and ZIP code should I record?”
Use the two-letter state abbreviation and exact ZIP.
3. Capture the Emergency Contact
Contact name
“Who should we contact in case of emergency? Please spell their full name.”
Use Last Name, First Name, Middle Name (if any).
Relationship
“What is this person’s relationship to you?”
Select the relationship provided.
Contact phone
“What is their best phone number?”
Capture and read back all digits.
Contact email
“What is their email address? Please spell it for me.”
Enter and confirm the complete address.
4. Capture Insurance-Card Information
Transition: “Thank you. Next, please have your insurance card available. I’ll record what appears on the card; coverage will be verified after our call.”
Insurance company / payer
“What insurance company is listed on the card?”
Enter the payer exactly as shown.
Plan type
“What plan type is shown, such as HMO, PPO, or another type?”
Enter the card wording when available.
Member ID
“Please read the Member ID exactly as it appears, including letters.”
Do not omit letters, zeros, spaces, or suffixes.
Group number
“What Group Number is listed?”
Enter the complete value.
Subscriber name
“Whose name is listed as the subscriber or policyholder? Please spell it.”
Use Last Name, First Name, Middle Name (if any).
Subscriber DOB
“What is the subscriber’s date of birth?”
Select the exact date.
Relationship to subscriber
“What is your relationship to the subscriber?”
Record Self, Spouse, Child, or the stated relationship.
Provider Services
“What Provider Services phone number is printed on the card?”
Capture the number used for professional verification.
Insurance read-back: “I recorded [payer], Member ID [read in chunks], Group Number [read in chunks], with [subscriber name] as the subscriber. Is each item correct?”
5. Understand the Appointment Need
Transition: “Now I’ll ask about the appointment you need so I can route you to the correct specialty, visit type, and provider.”
Reason for appointment
“In your own words, what is the main reason you are requesting this appointment?”
Summarize naturally while preserving the patient’s meaning.
Duration / clinical context
“How long has this been going on, and is there any important background the provider should know?”
Capture useful context without adding conclusions.
Referring provider / PCP
“Were you referred by a provider or your primary care provider? If yes, who?”
Record the provider’s name when supplied.
Referral source
“How did you learn about this clinic or service?”
A natural summary is acceptable.
6. Select the Scheduling Route
Specialty
Use the stated reason, referral information, and provider directory to identify the correct specialty.
Choose the specialty supported by the case information.
Visit type
“Is this a new consultation, follow-up, procedure-related visit, or another type of appointment?”
Choose a visit type available for the specialty/provider.
Selected provider
“Do you have a requested provider?” “I’ll review the appropriate providers for this specialty.”
Choose a provider whose specialty and visit types match.
Preferred days
“Which days of the week generally work best for you?”
Natural wording is acceptable.
Preferred time
“Do you prefer morning, afternoon, or a particular time range?”
Natural wording is acceptable.
7. Offer and Book an Appointment
First option
“I have [day, date] at [time] available. Would that work for you?”
Offer only an available slot.
Second option
“I also have [day, date] at [time]. Which option do you prefer?”
Offer a second reasonable option when possible.
Blocked request
“That requested time is not available. I can check another time that day or the next preferred day. Which would you prefer?”
Do not offer booked, blocked, or clinic-closed times.
Selected appointment
“To confirm, you selected [day, date] at [time] with [provider]. Is that correct?”
Select from the options offered, then book the appointment.
Scheduling notes
Document options offered, patient preference, instructions, or escalation.
Keep notes concise, objective, and relevant.
Flexible appointment rule: The patient may select any valid available slot you offered. The audit verifies that the final appointment was offered, selected, and booked; it does not require one predetermined date or time.
8. Run the Scheduling & Intake Audit
After booking, select Review & Validate Intake. Scheduling & Intake cannot close and Insurance Verification cannot unlock until every audited item passes.
Match
No correction is required.
The captured information meets the case requirement.
Needs Review
Select Go Back & Review Fields. Re-check your notes or ask an appropriate verification question.
The field is identified, but the answer is not revealed.
Missing
Return to the highlighted field and obtain or enter the missing information.
Do not guess or leave the item blank.
Re-run audit
After corrections, return to Scheduling and select Review & Validate Intake again.
All items must display Match.
Professional recovery: “I want to verify one detail before we finish. Could you please repeat [name of field]?”
9. Close the Patient Call
Appointment summary: “[Patient name], your appointment is scheduled for [appointment date and time] with [provider]. Please arrive 15 minutes early and bring a valid photo ID, your current insurance card, a list of medications, and any referral or order you were given.”
Required disclaimer: “Our team will verify your insurance eligibility and benefits after this call. Benefit information is not a guarantee of coverage or payment, and any required authorization must be completed before the service. Please contact the clinic if your insurance changes, your symptoms worsen, or you need to reschedule.”
Final question: “Do you have any questions before we end the call?”
Confirm identity, contact, address, emergency contact, and insurance details.
Confirm the appointment need, referral details, specialty, visit type, provider, and preferences.
Confirm a valid offered slot was selected and booked.
Continue only after every audit item displays Match and the audit passes.
Read the appointment summary, arrival instructions, and insurance disclaimer.