RTE Verified Statuses
RTE is down and Navinet was used to verify the patient's Aetna insurance, what verified status should be used?
What is "Verified by Website"
RTE is an important part of what job Roles?
What is Registration, Scheduling, Billing and any department that can change or add insurance to a patient's account
What is the maximum number of attempts that should be made to send an RTE request?
What is "3 attempts"
Which section of the RTE response will display important information such as Replacement Plan Returned or alternate or additional payor?
What is "Alerts Section"
What section of the RTE displays the copay, deductible, and coinsurance amounts?
What is "Benefits Section"
The patient's insurance is not RTE enabled, a phone call was made to ABC insurance company to verify coverage, what verified status should be used?
What is "Verified by Phone"
This occurs when an ineligible or incorrect insurance plan is added to an account and a claim is sent to the wrong payor?
What is "Insurance Denial"
RTE connectivity issues or unable to respond at the current time errors should be reported to what department?
What is "Information Technology Help Desk via Service Now"
This functionality refers to matching exactly the patient's insurance plan to the correct insurance plan in Epic?
What is "1:1 Plan Mapping"
This department determines how often a new RTE request should be sent for a particular insurance payor?
What is "The Business Office"
You need to re-run an RTE request after correcting the patient's Subscriber ID number, what verified status should be used?
What is "New"
This can occur when a claim is not submitted within an insurance company's required time frame ?
What is "Untimley Filing"
How would you verify an insurance that is not RTE enabled?
What is "Verify by phone or Website (ex - Navinet)
This RTE functionality will automatically populate the patients out of pocket amount due per visit or the _____ for the ER, Care Now, MRI/CT?
What is "Copay due"
Epic interfaces with ____________, a clearinghouse that is connected to the most common insurance payors?
What is "Experian"
RTE is down and you are unable to verify the patient's insurance by phone or website, what verified status would you use?
What is "Needs Review"
This can occur when authorization is not obtained for the correct payor?
What is "Claim amount written off"
Why is it important to review the entire RTE response even with a status of Eligible?
what is " copays could be missed, missed secondary/primary/additional payors, possible limited benefits (mental health only), no benefits for the service (plan does not cover the service),
This RTE functionality will occur when a payor chained coverage cannot auto create because of missing information such as the subscriber ID?
What is "Possible Coverage to Create"
Never mark an RTE response as ______or ______ unless you have actually done this ?
What is "Verified by Phone or Website"
RTE allows health care providers to verify a patient’s __________ prior to or on the date of service?
What is "Insurance Coverage"
Name 3 categories of an eligibility response that users should pay special attention to?
What is "Data Mismatches, Alerts, Other Entities/Additional Payor, Eligibility Status, Benefits"
This functionality allows the user to send a query for a particular insurance plan. If the system detects another or additional plan, a second RTE will be sent and the correct plan will be added to the patients account automatically
What is "Payor Chaining"
How often does RTE generate a new eligibility request to the payor for commercial payors (Blue Cross, Aetna, Highmark, Cigna, etc.)?
What is "Last day of every month"