Insurance Verification
This tool in Epic is used to check eligibility in real time.
What is RTE?
These are the three key identifiers used to confirm a patient’s identity.
What are name, date of birth, and medical record number?
This is required before many imaging tests for commercial insurance patients.
What is prior authorization?
This is the fixed amount a patient pays at the time of service.
What is a copay?
This button helps pull insurance information directly into the system to reduce errors.
What is “Pull Info”?
This type of plan often requires referrals and has a primary care physician.
What is an HMO?
This document must be signed before treatment to acknowledge financial responsibility.
What is a consent or financial agreement?
These codes describe the procedure being performed for billing purposes.
What are CPT codes?
This is the amount a patient must pay before insurance starts covering services.
What is a deductible?
This account type is used for hospital billing.
What is HB?
When coverage is active but services require approval before being performed.
What is prior authorization?
This process involves collecting demographic and insurance information before arrival.
What is pre-registration?
These codes support medical necessity for services.
What are diagnosis codes (ICD-10)?
This tool estimates patient responsibility using CPT codes.
What is an estimator?
This account type is used for professional billing.
What is PB?
This number identifies the patient under their insurance plan.
What is a member ID?
This error can lead to duplicate records in the system.
What is duplicate MRN creation?
This role often coordinates between radiology and the ordering provider to fix orders.
What is a scheduler or authorization coordinator?
This is when a patient pays part of the cost after insurance processes the claim.
What is coinsurance?
These notes are used to document verification details and communication.
What are HAR notes?
This situation occurs when a patient has more than one active insurance policy.
What is coordination of benefits?
This Epic activity shows a snapshot of patient information including balances and coverage.
What is the Storyboard?
This happens when the diagnosis does not support the ordered test.
What is a medical necessity denial?
This plan allows patients to pay their balance over time.
What is a payment plan?
This documentation phrase is used when eligibility is confirmed via payer portal.
What is “verified by website”?