Question

#12 a patient, who is a member under his spouses insurance, has an elapsed coverage. a week before the patients appointment, a batch job sends a query to humana. the response returns as eligible and files the data.

which foundation system general table did the system use?

select one of the following (1 pt)
a. 330011
b. 330012
c. 330002
d. 330001

Explanation:

Identify the scenario and query type

The scenario describes a patient who is a member under their spouse's insurance (subscriber is spouse, relationship is spouse) with elapsed coverage. A batch job queries Humana, and the response returns as eligible and files the data.

Determine the relevant Foundation System general table

In Epic Real-Time Eligibility (RTE) configuration, general tables are used to map external values to internal Epic values.

• Table 330011 is used for mapping subscriber relationship codes (e.g., mapping external X12 relationship codes to Epic's internal relationship list).
• Table 330012 is used for mapping subscriber sex/gender codes.
• Table 330002 is used for mapping eligibility status codes (e.g., mapping external EB01 eligibility/benefit codes to Epic's internal status).
• Table 330001 is used for mapping service type codes (EB03).

Since the scenario highlights that the patient is a member under his spouse's insurance (which determines the subscriber relationship), the system uses General Table 330011 to map the subscriber relationship code returned in the eligibility response.

Answer:

• (A) 330011 (Correct answer)
• (B) 330012
• (C) 330002
• (D) 330001