Patient Access Updates

Patient Access Training Corner

March 2014 Volume 4

When should Unlisted and Out of Network Plans be used?

Using Out of Network Plans

When there is not an IPA listed for a particular health plan use the Out of Network plan for that particular payor. For example:



  • Blue Cross with SDPMG should be entered as Blue Cross HMO Referral Out of Network for coverage


  • Aetna with SCMG should be entered as Aetna HMO Referral Out of Network for coverage


We should not use the Unlisted HMO plan as we already have Blue Cross and Aetna plans in EPIC.

Using Unlisted Plans

Unlisted plans should only be used when the plan does not exist in EPIC. This would be equivalent to a Miscellaneous HMO or PPO plan in PCIS. For example:



  • Peoples Health a Louisiana Medicare Advantage Plan would be entered as an Unlisted Medicare HMO Non Contracted Plan because it is a plan that is unlisted in EPIC for coverage


  • Eastern Connecticut Health Network PPO Plan would be entered as an Unlisted PPO Non Contracted Plan because it is unlisted in EPIC for coverage



In these instances we would use the unlisted plans in EPIC.

EPIC Address Updates

Address Link Field

There are different areas in a patient's record that will hold the patient's address. When updating a patient's address it is important to make sure it is updated in all of the appropriate areas. Using the Address Link field will ensure this.


When a patient's address is updated in the Patient Demographic screen:


  1. Select the green folder under Guarantor Accounts
  2. Select Pull Info to copy the new address
  3. Enter Yes in the Address link? field
  4. When the Link Patient and Guarantor Address screen appears select Copy patient address to guarantor.


After completing the linking the Address Update Confirmation window will appear to confirm the changes.


***Please not that if the patient is the subscriber the Address link should be used on the subscriber info form also.***

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