An episode of care is a record of when a healthcare organization coordinates your care for specific health conditions. Think of it as an organized care plan that groups related visits, treatments, and services together.

Episodes help ensure all aspects of your treatment are well-coordinated, with clear accountability and good communication between your healthcare providers.

Note: Only your healthcare providers can create or update episodes of care to ensure proper coordination by qualified professionals.

 

What's in Your Episode Records

Basic information:

  • Status: Current state (planned, active, finished, etc.)
  • Type: Kind of care coordination (specialist referral, disease management, etc.)
  • Care period: When the organization coordinates your care
  • Care manager: Who's coordinating your episode
  • Care teams: Other teams involved in your care

Detailed information:

  • Conditions being treated: What health problems this episode addresses
  • Diagnosis roles: Why each diagnosis matters (primary, billing, etc.)
  • Status history: How your episode has progressed over time

 

Episode Status Types

  • Planned: Episode planned but not started yet
  • Waitlist: You're waiting for the episode to begin
  • Active: Currently receiving coordinated care
  • On-hold: Temporarily paused
  • Finished: Successfully completed
  • Cancelled: Cancelled before completion

Common types of episodes:

  • Chronic disease management: Ongoing care for diabetes, heart disease, arthritis
  • Specialist referrals: Coordinated care with cardiologists, orthopedists, neurologists
  • Surgical episodes: Pre-operative, surgical, and post-operative care coordination
  • Rehabilitation: Physical therapy, cardiac rehab, stroke recovery services
  • Maternity care: Prenatal, delivery, and postpartum care coordination
  • Mental health treatment: Coordinated psychological or psychiatric care

 

How to Use Your Episode Information

Understanding your care:

  • Know which organization is coordinating your care
  • Identify your care manager and care team members
  • Understand what conditions are being managed
  • Track your progress through different care phases

For insurance and billing:

  • Provide episode information for pre-authorizations
  • Understand coverage for coordinated care services
  • Reference episodes when discussing care with insurance

Questions to ask your care team:

  • "Who is my care manager for this episode?"
  • "What's the plan for this episode of care?"
  • "How long is this episode expected to last?"
  • "What happens when this episode ends?"

 

Getting the Most from Your Episodes

Stay informed:

  • Review your active episodes regularly
  • Understand what each episode covers
  • Know who to contact for each episode
  • Ask about coordination between different episodes

Communicate effectively:

  • Tell all your providers about your active episodes
  • Share episode information during emergency visits
  • Keep your care manager updated on changes
  • Ask how different episodes work together

Episodes represent organized care coordination for your specific conditions. Understanding them helps you participate actively in your care.