Coverage Set up Flashcards
What is a Financial Class?
A category list used to group payors for reporting, pricing and claims functionality e.g. commercial, Medicare
What is a product type?
Category list used to group benefit plans for reporting purposes. e.g. HMO, FFS, PPO
Which Master File are Benefit plans stored?
Benefit Plan (EPP) master file.
Benefit plans use ________________________ to define a plan’s benefits
Benefit packages.
Benefit plans and benefit packages work together to do what?
Define what types of services are covered and to what extent they are covered.
What does the benefit engine do during charge entry?
The Benefits Engine determines which procedures are covered and not covered.
Which applications use the benefits engine in Epic?
Cadence, Adt, Resolute PB and Tapestry.
How does a benefit package adjudicate charges?
After adding a benefit package to the plan and setting the released? field to YES, the system will adjudicate services covered by the plan.
What is one reason for assigning each payor to a financial class?
Grouping, reporting,
True or False: If you restrict a payor or plan by service area, the payor or plan cannot be used in the service area listed.
False. It can only be used in the service area listed
True or False: Benefit packages can be attached directly to a payor record.
False. Benefit packages can only be attached directly to a benefit plan and the plan is then attached to payor records.
A benefit plan can be attached to how many payors?
One.
What is a payor?
A payor is an organization like an insurance company from which your organization receives payments/remittance.
What is a benefit plan?
A benefit plan is a specific grouping of benefits offered by a payor
What does CDF stand for?
Claims Definition File
