The Achievement plan problem: The HB Commercial CDF is listed as the CDF in the Acme payer record. What could be causing the problem?

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Multiple Choice

The Achievement plan problem: The HB Commercial CDF is listed as the CDF in the Acme payer record. What could be causing the problem?

The key idea here is how CDF values are chosen when both a payer and a plan specify one. In this system, plan-level settings can override payer-level settings, so the most specific configuration—the plan—takes precedence during claim processing. In your scenario, the payer record for Acme lists HB Commercial CDF, but the Achievement plan includes a different CDF. Because the plan defines its own CDF, that plan-level value is used for claims under that plan, effectively overriding the payer’s CDF. That’s why you’re seeing a discrepancy and the problem described. To fix this, align the plan’s CDF with the payer’s CDF (or remove the plan-level override so the payer’s CDF applies). The other options wouldn’t explain the observed override: a missing payer CDF would remove the value entirely, deprecation would cause warnings rather than a mismatch, and edit-check eligibility isn’t about which CDF is active.

The key idea here is how CDF values are chosen when both a payer and a plan specify one. In this system, plan-level settings can override payer-level settings, so the most specific configuration—the plan—takes precedence during claim processing.

In your scenario, the payer record for Acme lists HB Commercial CDF, but the Achievement plan includes a different CDF. Because the plan defines its own CDF, that plan-level value is used for claims under that plan, effectively overriding the payer’s CDF. That’s why you’re seeing a discrepancy and the problem described.

To fix this, align the plan’s CDF with the payer’s CDF (or remove the plan-level override so the payer’s CDF applies). The other options wouldn’t explain the observed override: a missing payer CDF would remove the value entirely, deprecation would cause warnings rather than a mismatch, and edit-check eligibility isn’t about which CDF is active.

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