5. Electronic Claim Responses
When Partner receives an electronic claim response from the insurance payor or the claim clearinghouse, a one-line message is added to oops. Here are two examples:
If the claims were sent through either the Medavant or Proxymed claim clearinghouses, you can review a more detailed response report from within the oops program. Press [F4 -- Insurance Status] and then select any billing response item that begins with "Payor Response" or that indicates a rejection or acceptance.
EXAMPLE 1: In the example below, you can see that the electronic claim clearinghouse (Proxymed) sent several messages to Partner regarding William Amis's visit on 01/06/06.
To read the full electronic report, press [F4 -- Insurance Status] and then select any entry beginning with "Payor Response" or "PROXYMED Accepted Claim":
Partner will open the relevant ECS report and display portions related to this patient that are on that report:
In the above example, the claim was accepted.
EXAMPLE 2: You can also review information about a rejected charge. In the next example, Female Baby Garg's immunization administration charge was rejected by the MVP insurance company:
To find out why the claim was rejected, press [F7 -- Insurance Status], enter the number next to the rejection, and press Enter:
Partner will display the segment of the report related to the patient, and you can read all the information that the insurance company (or claim processor) returned:
Using this feature, you can read your ECS reports (from Medavant or Proxymed) from within the oops program. You can also read ECS reports in your e-mail or through the ecsreports program. Read the ecsreports manual for more information.