Understanding RTE
This EPIC feature provides real-time insurance verification details.
What is Real-Time Eligibility (RTE)?
This information confirms the patient is currently insured
What is an 'active' eligibility status?
This type of mismatch occurs when the patient’s date of birth doesn’t match the insurance record.
What is date of birth data mismatch?
If the mismatch is due to incorrect coordination of benefits, this must be reviewed.
What is the insurance order in the Guarantor and Coverages tab?
An RTE error that says 'Coverage Not Found' may indicate this issue.
What is an incorrect subscriber or demographic mismatch?
This section in the RTE response shows coverage start and end dates.
What is the Subscriber Info section
This part of the eligibility shows what services are covered, like inpatient or outpatient care.
What is the Covered Services?
This mismatch happens when the insurance subscriber listed in EPIC is not the actual policyholder.
What is a subscriber data mismatch?
This tool can be used to manually verify eligibility and find the correct subscriber info.
What is Passport.
If FCS; by also calling the payer?
This term appears when a patient’s name or date of birth doesn’t match what the insurer has.
What is a data mismatch?
This is the term for an insurance plan that doesn't support RTE.
What is a non-RTE enabled plan
This value represents the fixed amount a patient pays at the time of service
What is a co-pay?
This field in EPIC must be corrected if the name submitted does not match the payer’s record.
What is the Payer Filed Name field?
If a patient’s last name is spelled incorrectly, this must be confirmed before making any EPIC changes.
What is verifying against the government-issued ID
This should be done when RTE eligibility fails but the patient confirms active insurance.
What is use Passport and document in Guarantor Notes?
If FCS agent: and call the payor
This response in RTE means you must contact the payer directly for verification.
What is 'Contact Payor'?
This value represents the amount a patient must pay before insurance begins to pay.
What is a deductible
This occurs when the patient is listed as the subscriber but is actually a dependent.
What is incorrect subscriber relationship data mismatch
When you suspect an incorrect COB setup of a Medicare patient, this workflow should be rechecked before escalating.
What is reviewing the MSPQ is filled out correctly?
This error happens when the same plan is entered more than once under different guarantors.
What is duplicate coverage error?
This step ensures EPIC records are aligned when RTE results don't match the patient’s insurance card.
What is add in the name returned from the insurance payer’s RTE response in Payer-Returned Demographics
This amount reflects what the patient may still owe after co-pay and deductible.
What is a co-insurance
When the insurance plan is correct but attached to the wrong guarantor account, this error appears.
What is incorrect guarantor listed, update correct guarantor
If Query Status states “Verification in Progress” what does that mean?
What is that the EPIC system is still processing the RTE and may take a few moments to return the eligibility.
This issue arises if a Medicare plan is listed but doesn't cover the scheduled service type.
What is invalid plan type for visit or billing issue?