Fun With Insurance Terminology

3. Term that means we have no contract with the payor. The patient may not have coverage and should consider finding an In Network provider - 3 words.
4. The type of plan directed by a PCP that requires patients to stay in their network to have benefits.
6. The flat fee you collect at time of service.
12. The RTE Response that may be returned if the group number is incorrect - 2 words.
15. Review this to address any errors or alerts returned by the RTE. You can also confirm the assigned PCP, Identify the Medicare Replacement Plan, & find Other or Additional Payor info - 2 words.
16. This happens when complete and accurate insurance info is not obtained during registration.
17. The RTE Response that may be returned if the subscriber ID number is incorrect - 2 words.
19. The 5 digit number on an insurance card that, when present, should be the primary search option when adding a new plan in Epic.
20. Working these timely will eliminate errors and ensure the claims drop timely.

1. This is required for a veteran choosing to use their VA benefits for services outside of a VA facility.
2. The RTE Response that indicates the payor is not RTE-enabled and requires manual verification via phone, website, etc - 2 words.
5. Resource on BEN to assist Front Desk Users during the registration process - 3 words.
7. The RTE Response that may be returned if the wrong insurance plan is added - 2 words.
8. The policyholder of an insurance plan.
9. A person or entity who is legally responsible for the patient’s account.
10. When a Medicare beneficiary has coverage thru this, Medicare is the secondary payor - 2 words.
11. Person that is available to support the front end workflows to ensure your success - 3 words.
13. If this is not completed correctly, Epic will “flip” the coverage order.
14. The Medicare Wellness Visit that must be done within the first 12 months of Part B eligibility - 3 words.
18. This is often required for HMO plans when seeking specialty care.