HMO, a. Referred to as Managed Care, e. Restricts patients to specific providers, i. Must choose a PCP, m. Referrals typically required, PPO, k. May receive services outside of network, b. Referrals are not typically required, o. Not required to choose PCP, g. Preferred Provider Organization, EPO, f. Patient must receive care from exclusive providers contracted with their plan, l. Not required to choose a PCP, n. Pre-authorization required for most services, c. No out-of-network coverage (except emergencies), Commercial Generic, d. Designed for health coverage that does not have a designated plan code, h. Will always require manual insurance verification, j. The claims address in Epic must match the card exactly, p. Not to be used for Auto, W/C, Medicare, or Medicaid.

Mapping Coverage Paths

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