General
The insurance company who holds the insurance plan. Examples: Medicare, Medicaid, Aetna, Horizon
What is a Payor
What logic in Epic helps determine filing order?
What is FOAL/Filing Order Adjustment Logic
Why is the Out of Network process in place?
What is a Federal Mandate/law?
The specific insurance policies under the insurance carrier. Examples would be Health Maintenance Organizations(HMOs), Exclusive provider organizations(EPOs), Point of Service(POS), Preferred provider organizations (PPOs).
What is a plan
What will display as able to select if FOAL indicates the filing order is incorrect?
What is the Use Default button
Per federal mandate, when must the Out on Network workflow begin?
When is at time of scheduling the appointment
The website to open every day to support users on Insurances
What areas does FOAL look at within the registration to determine filing order?
What are:
Subscriber is covered through field
Covered through
Employee size
MSPQ for Medicare eligible patients
When must the Out of Network process be completed?
When is for every single encounter/visit
Where in Epic can you verify eligibility for a patient's coverage?
What is RTE/Real Time Eligibility
For Medicare Advantage plans, what is listed on the patient level versus the encounter level?
What are:
Reg level- Medicare Advantage plan and Medicare
Encounter level- Medicare Advantage plan
What must be signed for an Out of Network coverage for every encounter?
What is the Out of Network Informed Consent
What areas within the RTE should you look for every coverage to ensure you fully understand the patient's benefits?
What are:
Query Status
Alerts
Other Entities
Covered Services
Service area patient is receiving care
For Dual SNP plans, what is listed on the patient level versus the encounter level?
What are:
Reg level- Medicare Advantage plan, Medicaid Advantage plan, Medicare, and Medicaid
Encounter level- Medicare Advantage plan, Medicaid Advantage plan
What type of note and what smart should be used when calling a coverage to verify the patient's eligibility?
What is:
Note type- Insurance
Smart Text- CUH Insurance Verified by Phone Template