RTE Statuses
This status will return if the coverage is active for the patient.
What is E-Verified
This status will return if the patient has active coverage but the ID and/or group number is incorrect.
What is Needs Review
Medicare status is Replacement Plan Returned and indicates patient has auto insurance but visit isn't auto-related. What step should be taken?
What is change status to Manually Verified
Which section of the RTE response will display important information such as Replacement Plan Returned or alternate or additional payor?
What is "Alerts Section"
When does RTE need rerun for Medicaid and many commercial payors in Epic?
What is the first of the month
This status will return if the coverage is inactive for the patient.
What is E-Rejected
This status returns if the patient has another insurance primary or a different coverage than the one sent.
What is Replacement Plan Returned
Medicare status is Replacement Plan Returned and indicates patient has a Medicare Advantage plan. What steps should be taken?
What is term Medicare and create Advantage Plan coverage if verified.
If a coverage is plan mapped, what will automatically happen when RTE is run and the plan is verified?
What is create the coverage in Epic.
What is manually entered in a coverage's Effective To field if the RTE status is E-Rejected but the response doesn't give an Effective To date?
What is T-1
The insurance is not RTE enabled or RTE is down, so ABC insurance company was called to verify coverage. What status should then be used?
What is Manually Verified
This status populated because the ID# was entered with 2 numbers transposed so RTE can't identify the patient.
What is Error
Status for Aetna is Other or Additional Payor. Response indicates other payor is a prescription plan. What step needs taken?
What is Change Aetna status to Manually Verified
The RTE functionality will automatically populate this in Epic under the patient's visit registration.
What is Copay
What section of the RTE displays the copay, deductible, and coinsurance amounts?
What is "Benefits Section"
This status indicates the Epic Verification needs rerun.
What is Elapsed
This status returns if the Highmark BS RTE response indicates the patient actually has Highmark Individual ACA.
What is Plan Mismatch
RTE status is Needs Review and indicates group # is different that one that was sent. What steps should be taken?
What is term current coverage and create new plan with the correct group #.
What does RTE do if a coverage that is already built in Epic comes back E-Rejected with an Effective To date in the response?
What is automatically term the insurance
What should a patient be told if their insurance comes back inactive but they insist they have it?
What is "ask them to call insurance company and let them know the visit will be self-pay until we have a verified insurance to add. "
RTE is down and insurance was not verified by phone or website. What status should be used?
What is Card/Phone Reviewed
If Highmark RTE response indicates the patient also has Medicare what is the status of the response?
What is Other or Additional Payor
Medicare status is Replacement Plan Returned and indicates patient has auto insurance. This visit is for an auto injury. What steps should be taken?
What is mark Medicare as Manually Verified and switch visit to auto account/coverage. Add Medicare as secondary.
If either of these 2 statuses return for a new coverage, RTE will ignore the response and not allow the plan to be created.
What is E-Rejected or Not Eligible
What 4 situations would lead to possibly using Manually Verified for the status?
What is 1. Non-verifiable insurance 2. RTE down and verified via payor website or phone call 3. Other or Additional payor response if insurance is correct and active 4. Replacement Plan Returned response and insurance is correct and active.