Glossary: Alma and Insurance Terminology

Term	Definition
Almabot	Almabot is an automated chat feature available to members in the Alma portal. Almabot is automated 24/7 support designed to find relevant information and resolve common issues.
Alma directory	The Alma directory houses all public provider profiles. Clients can search and filter their search results in the Alma directory to find a provider that best suits their needs.
Alma Portal	The Alma portal is where providers access their client lists, submit claims, create invoices, review consultation requests, schedule sessions, and more.
autopay	When a client opts in to autopay, Alma can automatically charge the card on file for future sessions.
chart notes	Alma providers can use chart notes to add information to a client’s record that is not tied to a specific session. Examples of this type of information include phone calls, text messages, emails, vitals, and medication history.
client intake	The client intake process helps providers gather all of the information and documentation they need to work with a new client. This includes documentation (like clinical assessments and consent forms), as well as an intake session.
client referral	When a provider cannot accept a prospective client (either because of ethical reasons or scheduling availability), they may make a client referral to another provider.
clinical assessments	Clinical assessments, or assessments, are questionnaires that providers use to screen, diagnose, and evaluate the severity of a range of mental health disorders. Members can send PHQ-9 and GAD-7 assessments to clients in the Alma portal. They can also set up automated reassessments for clients with elevated scores.
Community Hub	Alma members can communicate with one another in the Community Hub, a platform designed to foster connection and enable the sharing of resources. This is also where Alma hosts and supports programs like clinical interest groups, shares upcoming community events, and posts on-demand webinars. etc.
Community Town Hall	Each quarter, Alma members can virtually join a Community Town Hall meeting to hear from and engage with the Alma team. Alma founder and CEO Harry Ritter leads these meetings and is often joined by other executive members of the Alma team.
consent forms	Alma members can send consent forms in the portal. These forms represent an agreement between the provider and the client that the client must review and sign before starting care.
consultation	A consultation is a brief meeting to determine whether a provider is the right fit for a prospective client. Please note that a consultation is not an “appointment” or a “session.” Consultations are usually at no cost to the prospective client, though this varies based on providers’ individual practice policies.
consultation availability	Providers can share their consultation availability to their profile in the Alma directory so that prospective clients can see when they might be available. This allows prospective clients to self-schedule a consultation, rather than submitting a request and waiting to hear back.
copay	A copay is a predetermined flat fee, outlined by a client’s insurance company, that the client pays to an in-network provider.
cost estimator tool	Alma’s free cost estimator tool helps clients quickly determine the cost of their copay, as well as how close they are to meeting their deductible. This tool can currently show estimates for clients insured by Aetna, UHC, Optum, and Cigna.
deductions	Deductions occur when Alma deducts funds from a payout that was previously dispersed to a provider. For example: When a provider submits a claim for a session with their Alma client, they will be paid by Alma within two weeks of submitting that claim. If the client does not pay their invoice within 60 days, the client’s payment responsibility is then deducted from the provider’s upcoming payout, so the provider can go on to collect payment from this client how and when they see fit. For more information on deductions, review our denial policy.
filters	When browsing the Alma directory, clients can use filters for provider identity, specialty, language, therapeutic approach, and more to find someone who meets their needs.
Electronic Health Records (EHR)	Electronic health records, or EHRs, contain a person’s medical history, diagnoses, medications, treatment plans, and other information related to their health. Mental health care providers use EHRs to keep client records secure and simplify administrative tasks.
health care	Health care is an umbrella term that includes any effort to prevent, diagnose, and treat illness or injury, as well as manage physical, mental, and emotional well-being.
HIPAA	The Health Insurance Portability and Accountability Act, or HIPAA, protects clients’ health care data.
in-network/in network	If a client sees a provider who’s in network, their insurance will pay for at least part of the cost. This is considered in-network care.
Insurance plan	An insurance plan is a specific policy offered by an insurance company.
insurance program	When a provider gets credentialed with an insurance company through Alma, they are joining Alma’s insurance program.
invoice	Providers can create invoices in the Alma portal. These invoices may be for the cost of a session out-of-pocket, a cancellation fee, or collecting the payment responsibility/copay for an outdated insurance claim submission.
lapse of coverage	When a client does not have active insurance coverage for a period of time, this is considered a lapse of coverage. Any sessions that take place during this time are not eligible for in-network coverage.
medical audit	A medical audit involves the collection and clinical review of medical records (e.g. progress notes) and related information to ensure that payment is made only for services that meet all coverage, coding, billing, and medical necessity requirements. This is often called an audit.
Medicaid	Medicaid is the U.S. public health insurance program for people with low income, administered on a state-by-state basis. Alma does not currently accept it.
Medicare	Medicare is the federal government program that provides health care coverage for those 65+, those under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, and those under 65 with End-Stage Renal Disease (ESRD). Alma does not currently accept it.
member	Any provider who joins Alma is a member.
modality	In the context of mental health care, a modality is a specific approach to treatment. For example, cognitive behavioral therapy (CBT), and Eye Moevement Desenetization and Reprocessing (EMDR), are evidence-based modalities. At Alma, clinicians can specify the modalities they use to help clients find them in the directory where they are listed as ‘therapeutic approaches.’
out-of-network /out of network	If a client sees a provider who’s out of network, their insurance may not cover the cost. This is considered out-of-network care.
out-of-pocket/out of pocket	If a client’s sessions aren’t covered by insurance, they’ll pay for care themselves out of pocket, without any expectation of reimbursement from the insurance company. This is called an out-of-pocket expense.
Patient Health Information (PHI)	A client’s protected health information, or PHI, includes records, invoices, and other identifying information, all of which are protected under HIPAA.
payment responsibility	Alma bills clients for their payment responsibility as outlined by their insurance provider.
payout	A payout is when a provider gets paid by Alma, which happens each week.
policyholder	The person who holds an insurance policy is a policyholder. When inputting insurance plan details to the Alma portal, any dependent on an insurance plan will need to include the policyholder’s name and date of birth.
primary insurance	The insurance company with the first responsibility for the payment of a claim is primary insurance.
prior authorization	With some insurance plans, certain treatments require approval from the insurance company before the client receives care. This is called prior authorization. Some plans may only authorize a certain type of care, or a specific number of visits.
provider	A provider, in Alma’s context, is anyone who offers mental health care to clients.
rates	Payout rates are the amounts a provider is paid for specific types of care by specific insurance payers. Insurance payers determine these rates based on the provider’s degree and the CPT code used in each session.
referral for care	Some plans require a referral for care from a Primary Care Provider before the plan will authorize the client’s eligibility to see a mental health provider at in-network rates.
retroactive termination	Retroactive termination is the assignment of a new end date to an insurance policy, typically because the premium is not being paid. The new end date assigned is usually the date that the plan’s premium was last paid; any claims filed after that date will be denied. When Alma receives notice of a client’s retroactive termination, we notify the client and the provider immediately. The client can then determine whether their policy can be reinstated, or work with the provider to establish an out-of-pocket rate.
secondary insurance	The insurance company responsible for processing a claim after the primary insurance determines what it will pay is secondary insurance.
session	In Alma’s context, a session is a scheduled meeting between a client and a provider. This can also be called a therapy session or, in certain cases, a medication management session.
sliding scale	A sliding scale is a range of out-of-pocket fees that providers accept based on a client’s financial need.
superbill	A superbill is a summary of visits from the previous month that can be submitted to an insurance payer for reimbursement. Superbills are typically used for out-of-network reimbursement.
teletherapy / telemedicine	Teletherapy and telemedicine are both ways for providers to see clients virtually without an in-person visit.
therapist	A therapist is a licensed mental health care professional who helps clients improve their mental health, primarily through communication and interaction.

Glossary: Alma and Insurance Terminology

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