[reg] FW: EMPIRE PLAN - Important to Read and SHARE

Fri Sep 20 08:23:46 EDT 2024

Brenda Passardi, CHAM
Performance Improvement Manager
Upstate University Hospital
Phone: Available on Teams
Email: passardb at upstate.edu

From: Kaniesha Mason <BarnettK at upstate.edu>
Sent: Friday, September 20, 2024 5:40 AM
To: Brenda L. Passardi <PassardB at upstate.edu>
Subject: Fw: EMPIRE PLAN - Important to Read and SHARE

Please send through the listserve.

Kaniesha

Kaniesha M Mason

Director of Registration

University Hospital RM 1321D

Syracuse, NY 13210

315-464-3967 office

315-526-0514 cell

________________________________
From: Jackie Wheeler <WheelerJ at upstate.edu<mailto:WheelerJ at upstate.edu>>
Sent: Friday, September 20, 2024 3:40 AM
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Subject: EMPIRE PLAN - Important to Read and SHARE

Hi All,

Please share this with all staff that have anything to do with Epic registration, billing or anything related to patient insurance coverage.

Back on 9/12/24 we went live with a change for Empire Plan insurance assignment.  Attached is the System Update Bulletin that went out regarding this change.  In a nutshell... the change is that for patients that have Empire Plan insurance we now need to add Empire Plan UHC and Empire Plan BC on the patient level.  We added query chaining logic that when an Empire Plan UHC query is sent to UHC and comes back as eligible a query would automatically be sent to BC/Excellus.  Once both coverages are on a patient there is logic that when the patient is registered that the needed coverage will be what is applied to the appointment/encounter level.

Ex:  Patient with Empire Plan (both coverages are on the patient level)... has an appointment in a clinic or one of the private practices.... The Empire Plan UHC would default on the appointment (encounter) for that visit.

Ex:  Patient with Empire Plan (both coverages are on the patient level)... comes into the ER.... Empire Plan BC would default as the coverage for that visit.

However, we ran into an issue that if the patient has Medicare and Empire Plan... the query chaining going out to BC/Excellus was pulling in the Medicare ID instead of the Empire Plan ID with the YLS prefix.  With the incorrect ID we were getting a 'Could Not Process' response from the payor.

Tonight, I have applied additional build that is correcting this issue and is now pulling in the correct Empire Plan ID with the YLS prefix to send the query to BC/Excellus.  HOWEVER, when the Notification comes back from BC/Excellus you will see the following in the Checklist.....

[cid:image001.png at 01DB0B0C.0FDA9D20]

Click on this Notification and it will bring you to the RTE response that would state the coverage is E-Verified and would have an Alert advising that both Empire Plan UHC and Empire Plan BC should be created. There could be other Alerts also.

[cid:image002.png at 01DB0B0C.FA6F68C0]

In the top right of the screen, under the Action Taken section...you need to click on the 'Green Check Mark Acknowledge' button to apply the coverage onto the patient.

[cid:image003.png at 01DB0B0D.48403750]

I will continue to work on this to get the coverage to automatically add without the need to click this.  This fix is better than getting the 'Could Not Process' response.

Thank you for your patience, it is greatly appreciated.

Jackie

Jackie Wheeler, Sr Programmer/Analyst

SUNY Upstate Medical University

IMT-HEART (Health Information Management Access, EDI, Revenue Cycle & Training)

447 S Salina St, 5th Floor

Syracuse NY 13202

wheelerj at upstate.edu<mailto:wheelerj at upstate.edu>

315-214-9896 (Cell)

[cid:image004.jpg at 01DB0B0E.E55E6CE0]

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Subject: [EpicSchedRegPAS] System Update Bulletin - Coverages - Adding and Assigning Empire Plan UHC & BC
Date: Wed, 4 Sep 2024 16:05:32 +0000
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