EPIC INSURANCE & COORDINATION OF BENEFITS
2026/2027 | Complete Solutions for Insurance Points & COB |
Hyperspace Certification Prep | Pass Guaranteed - A+
Graded
Insurance Plan Types & Fundamentals (Questions 1-12)
Q1: You're verifying insurance for a 45-year-old patient who presents with a commercial
insurance card from Blue Cross Blue Shield and mentions they also have coverage
through their spouse's plan. What is your first step in Epic to ensure proper claims
processing?
A. Enter only the patient's own insurance and ignore the spousal coverage
B. Add both insurance plans in Epic's Insurance tab and mark the appropriate
Coordination of Benefits order [CORRECT]
C. Call the patient back next week to verify insurance
D. Enter the spouse's insurance as the primary regardless of other coverage
Correct Answer: B
Rationale: Epic requires all active insurance plans to be entered with proper COB order
designation (primary, secondary, tertiary) to ensure claims are submitted to the correct
payer first. Ignoring coverage (A) causes denials. Delaying verification (C) delays
care/billing. Assuming spousal coverage is primary (D) violates COB rules—birthday rule
or other criteria determine order.
Q2: A patient presents with TRICARE coverage and informs you they are also enrolled in
Medicare Part A and B due to disability. Which payer is typically primary for this patient's
services?
,A. TRICARE is always primary regardless of circumstances
B. Medicare is primary for disability beneficiaries under 65, with TRICARE as secondary
[CORRECT]
C. The patient must choose which is primary each visit
D. Both payers are primary simultaneously
Correct Answer: B
Rationale: For TRICARE beneficiaries entitled to Medicare due to disability (under 65),
Medicare is primary payer and TRICARE acts as secondary. This is a specific Medicare
Secondary Payer exception. TRICARE (A) is primary only when Medicare doesn't apply.
Patients cannot choose (C), and dual primary (D) violates COB principles.
Q3: You're setting up a new insurance plan in Epic's Resolute module. The plan is a
Medicare Advantage plan (Part C). How should this be classified in Epic's Plan Type
field?
A. Commercial insurance
B. Medicare Part A only
C. Medicare Advantage (Part C) [CORRECT]
D. Medicaid
Correct Answer: C
Rationale: Medicare Advantage (Part C) plans must be classified correctly in Epic to
trigger appropriate Medicare Advantage edits, prior authorization requirements, and
claims submission rules. These are distinct from Original Medicare (A/B) and
commercial plans. Misclassification causes claim routing errors and payment delays.
Q4: A workers' compensation case comes to your registration desk. The injury occurred
at the patient's workplace yesterday. What is the correct insurance setup in Epic?
,A. Enter the patient's commercial insurance as primary and ignore workers' comp
B. Enter workers' compensation as primary for the work-related injury, with commercial
insurance potentially as secondary [CORRECT]
C. Bill commercial insurance first and let them sort it out
D. Refuse to treat the patient until workers' comp is resolved
Correct Answer: B
Rationale: Workers' compensation is primary payer for work-related injuries/illnesses
per state law. Commercial insurance may provide secondary coverage for costs not
covered by workers' comp. Ignoring workers' comp (A, C) violates state regulations and
payer contracts. Refusing treatment (D) violates EMTALA and patient care standards.
Q5: A 68-year-old patient has both Medicare Part B and a retiree health plan from their
former employer with 500+ employees. Which payer is primary for outpatient services?
A. The retiree plan is always primary for retirees
B. Medicare is primary because the employer has fewer than 20 employees
C. Medicare is primary because the employer has 20+ employees [CORRECT]
D. The patient chooses primary payer at each visit
Correct Answer: C
Rationale: For individuals 65+ with employer group health plan (EGHP) coverage: if
employer has 20+ employees, Medicare is primary; if fewer than 20, EGHP is primary.
This patient's employer has 500+ employees, so Medicare is primary for outpatient
services. The 20-employee threshold is critical for Medicare Secondary Payer
determinations.
Q6: In Epic's Prelude module, you're entering insurance information and see the "COB"
field. What does this field determine?
, A. The patient's copayment amount only
B. The order in which insurance plans pay claims (primary, secondary, tertiary)
[CORRECT]
C. Whether the patient has insurance at all
D. The patient's deductible amount
Correct Answer: B
Rationale: The COB (Coordination of Benefits) field in Epic designates the payment
order—primary (1), secondary (2), tertiary (3)—ensuring claims submit to the correct
payer first and subsequent payers receive appropriate COB information. This prevents
duplicate payments and ensures proper liability determination. It doesn't set copays (A),
determine coverage existence (C), or set deductibles (D).
Q7: A patient has auto insurance medical payments (MedPay) coverage after a car
accident and also has personal health insurance. For accident-related medical
treatment, which is typically primary?
A. Personal health insurance always pays first
B. Auto MedPay is primary for accident-related treatment, with health insurance as
secondary [CORRECT]
C. The patient must pay out-of-pocket first
D. Both payers split the cost equally
Correct Answer: B
Rationale: Auto insurance MedPay or Personal Injury Protection (PIP) is primary for auto
accident-related injuries. Health insurance provides secondary coverage. This is a
standard COB rule for liability/no-fault situations. Personal health insurance (A) is
incorrect for accident-related care. Patient payment (C) and equal splitting (D) violate
standard COB protocols.
2026/2027 | Complete Solutions for Insurance Points & COB |
Hyperspace Certification Prep | Pass Guaranteed - A+
Graded
Insurance Plan Types & Fundamentals (Questions 1-12)
Q1: You're verifying insurance for a 45-year-old patient who presents with a commercial
insurance card from Blue Cross Blue Shield and mentions they also have coverage
through their spouse's plan. What is your first step in Epic to ensure proper claims
processing?
A. Enter only the patient's own insurance and ignore the spousal coverage
B. Add both insurance plans in Epic's Insurance tab and mark the appropriate
Coordination of Benefits order [CORRECT]
C. Call the patient back next week to verify insurance
D. Enter the spouse's insurance as the primary regardless of other coverage
Correct Answer: B
Rationale: Epic requires all active insurance plans to be entered with proper COB order
designation (primary, secondary, tertiary) to ensure claims are submitted to the correct
payer first. Ignoring coverage (A) causes denials. Delaying verification (C) delays
care/billing. Assuming spousal coverage is primary (D) violates COB rules—birthday rule
or other criteria determine order.
Q2: A patient presents with TRICARE coverage and informs you they are also enrolled in
Medicare Part A and B due to disability. Which payer is typically primary for this patient's
services?
,A. TRICARE is always primary regardless of circumstances
B. Medicare is primary for disability beneficiaries under 65, with TRICARE as secondary
[CORRECT]
C. The patient must choose which is primary each visit
D. Both payers are primary simultaneously
Correct Answer: B
Rationale: For TRICARE beneficiaries entitled to Medicare due to disability (under 65),
Medicare is primary payer and TRICARE acts as secondary. This is a specific Medicare
Secondary Payer exception. TRICARE (A) is primary only when Medicare doesn't apply.
Patients cannot choose (C), and dual primary (D) violates COB principles.
Q3: You're setting up a new insurance plan in Epic's Resolute module. The plan is a
Medicare Advantage plan (Part C). How should this be classified in Epic's Plan Type
field?
A. Commercial insurance
B. Medicare Part A only
C. Medicare Advantage (Part C) [CORRECT]
D. Medicaid
Correct Answer: C
Rationale: Medicare Advantage (Part C) plans must be classified correctly in Epic to
trigger appropriate Medicare Advantage edits, prior authorization requirements, and
claims submission rules. These are distinct from Original Medicare (A/B) and
commercial plans. Misclassification causes claim routing errors and payment delays.
Q4: A workers' compensation case comes to your registration desk. The injury occurred
at the patient's workplace yesterday. What is the correct insurance setup in Epic?
,A. Enter the patient's commercial insurance as primary and ignore workers' comp
B. Enter workers' compensation as primary for the work-related injury, with commercial
insurance potentially as secondary [CORRECT]
C. Bill commercial insurance first and let them sort it out
D. Refuse to treat the patient until workers' comp is resolved
Correct Answer: B
Rationale: Workers' compensation is primary payer for work-related injuries/illnesses
per state law. Commercial insurance may provide secondary coverage for costs not
covered by workers' comp. Ignoring workers' comp (A, C) violates state regulations and
payer contracts. Refusing treatment (D) violates EMTALA and patient care standards.
Q5: A 68-year-old patient has both Medicare Part B and a retiree health plan from their
former employer with 500+ employees. Which payer is primary for outpatient services?
A. The retiree plan is always primary for retirees
B. Medicare is primary because the employer has fewer than 20 employees
C. Medicare is primary because the employer has 20+ employees [CORRECT]
D. The patient chooses primary payer at each visit
Correct Answer: C
Rationale: For individuals 65+ with employer group health plan (EGHP) coverage: if
employer has 20+ employees, Medicare is primary; if fewer than 20, EGHP is primary.
This patient's employer has 500+ employees, so Medicare is primary for outpatient
services. The 20-employee threshold is critical for Medicare Secondary Payer
determinations.
Q6: In Epic's Prelude module, you're entering insurance information and see the "COB"
field. What does this field determine?
, A. The patient's copayment amount only
B. The order in which insurance plans pay claims (primary, secondary, tertiary)
[CORRECT]
C. Whether the patient has insurance at all
D. The patient's deductible amount
Correct Answer: B
Rationale: The COB (Coordination of Benefits) field in Epic designates the payment
order—primary (1), secondary (2), tertiary (3)—ensuring claims submit to the correct
payer first and subsequent payers receive appropriate COB information. This prevents
duplicate payments and ensures proper liability determination. It doesn't set copays (A),
determine coverage existence (C), or set deductibles (D).
Q7: A patient has auto insurance medical payments (MedPay) coverage after a car
accident and also has personal health insurance. For accident-related medical
treatment, which is typically primary?
A. Personal health insurance always pays first
B. Auto MedPay is primary for accident-related treatment, with health insurance as
secondary [CORRECT]
C. The patient must pay out-of-pocket first
D. Both payers split the cost equally
Correct Answer: B
Rationale: Auto insurance MedPay or Personal Injury Protection (PIP) is primary for auto
accident-related injuries. Health insurance provides secondary coverage. This is a
standard COB rule for liability/no-fault situations. Personal health insurance (A) is
incorrect for accident-related care. Patient payment (C) and equal splitting (D) violate
standard COB protocols.
