Review Archived EDI Reports

After you submit claims, your practice will receive clearinghouse and payor acknowledgements as well as ERAs and other electronic notifications from PCC, claim clearinghouses, and payors.

You can use tools in PCC EHR to review these responses. When you need to do deeper research, you can use the EDI Reports (ecsreports) program, which holds a library of all “Electronic Data Interchange” reports sent to your practice.

Learn All Steps for the Biller Role: This article is part of the New User Training for Billers. You can use that outline to learn how to complete all billing tasks in PCC EHR.

Contents

1 Read EDI Responses in the Billing History of the Chart
2 Read ERAs in the Electronic Remittance Advice Tool
3 Use EDI Reports (ecsreports) to Review Other Archived Communication

Read EDI Responses in the Billing History of the Chart

To view an encounter’s claim history, including the log of submission, acknowledgements, and all responses, visit the Billing History of the patient’s chart.

When an electronic record is available for a claim event, you can click on a link to open it.

Read Review an Encounter’s Billing History or Work on Claim Errors and Rejections to learn more.

Read ERAs in the Electronic Remittance Advice Tool

To review the complete details of a claim response from a payor, open the Electronic Remittance Advice Tool in PCC EHR.

ERAs provide the details about the payor’s adjudication, including payments, adjustments, denials, and unusual circumstances. Read the Read ERA 835s from Payors article to learn more.

Use EDI Reports (ecsreports) to Review Other Archived Communication

In addition to the communication you can review in context in PCC EHR, the EDI Reports (ecsreports) tool logs communication from clearinghouses, payors, and your third-party bill printing service.

Open the ecsreports program in your Practice Management windows.

Reports are grouped together by the date they were received, with the most recent delivery date appearing at the top. Press F8 – List By Type to review reports by type instead. For each report, you can see the title or type, the general category, the time it was received, and how many times it has been printed.

Your office can use this screen to review the history of EDI-related communication sent to your PCC system. If your practice prints ERAs, Bad Claim reports, or other claim responses you can use the “Times Printed” column to facilitate that workflow.

Reports Recycle: Because your practice receives thousands of reports every year, ecsreports does not keep all old reports on your system. Instead, reports will remain on the system for one to two years. If you would like to change the length of time that EDI reports remain on your system, contact PCC Support.

Open and Read a Report

Select any report and press F1 – View Selected to read it.

While viewing a report press Page Up or Page Down to scroll.

You can select more than one report in order to view them all at once in the same window:

Print an EDI Report

Select any report and press F2 – Print Selected to print it.

Find EDI Reports by Type

Press F8 – List By Type to see reports grouped by type. Reading and searching through a specific report type may be more convenient than viewing all the reports from a specific date.

The “By Report Type” screen displays all report types stored on your system. To view all available reports of a certain type, select the type and press F1 – Select Type. Press F12 to return to the listing by date.

Search an EDI Report

While viewing a report or multiple reports, press F8 – Search Pattern and enter text to perform a search:

After typing your search value, press Enter to scroll to the first matching value.

Matching items will be highlighted on the screen, and you can press F7 – Search For Next to scroll through all matching results.

Search Multiple EDI Reports

You may need to search through multiple reports for a name, certificate number, or other identifier. You might know in which report the information is located, or on what date you received the information.

Select Reports to Search

Select all the reports you would like to search:

Press F6 – Search Selected

Press F6 to begin your search.

Enter Search Text

On the File Search screen, enter the text for which you wish to search and press F1 – Process.

Whole Words?: If you wish to find your text pattern only as a whole word and avoid results that contain your text pattern as part of another word, change the “Search on whole words?” question to “Yes.”

Select Specific File From Results

The ecsreports tool will list all the files from your selection that contain the text for which you searched.

Select an individual report to review or press F3 – Select All to select all reports that contain your search pattern. Then press F1 – View Selected.

Review Result, Jump to Next

The ecsreports tool will display the first matching result. The search text will be highlighted:

Press F7 – Search For Next to scroll through each matching result.

Optionally, Change Search Pattern

Press F8 – Search Pattern to change the search pattern. You will continue to search the same files you selected in step four above.

Examples of Archived EDI Reports

Here are some reports you may find in the ecsreports program, along with sample text.

preptags/tagsplit Bad Claim Report

This report identifies claims that could not be approved for electronic submission. The PCC EHR Claims tool replaces this report. If you use the claims programs in Practice Management instead of PCC EHR, you will be prompted to print this report after you submit claims.

Bad Claim Report                        Generated On: March 11, 2005
Date: 03/10/05  PCC #: 243      Patient: Pebbles Flinstone
        Guar PCC#: 751          Cus PCC#: 751    
        Claim is for an insurance company no longer on the account            
        Charge filed with: Cigna $0

In the example above, a claim was rejected because the insurance company (Cigna $0) was no longer listed on the account. The insurance information was probably updated by another user, and the claim probably needs to be pended and re-batched in oops. It may already have been re-batched, but you should review the account to be certain.

ECS Batch Log

This report is a log, sorted by insurance batch and patient name, of all the claims sent out on a certain date. The PCC EHR Claims tool replaces this report. Your PCC system generates this report when it finishes processing and submitting claims.

Run date: 20050310
Batch: PCC – Aetna Claims           
03/08/05 * $ 111.00   – Flinstone, Pebbles
03/08/05 * $ 165.00   – Doe, Johnny
03/07/05 * $ 111.00   – Crusher, Wesley
03/08/05 * $  81.00   – Duck, Louie
Total claims processed: 4
Total claim charges: $468.00

The report excerpt above shows four claims that were sent out in the Aetna insurance batch on 3/10/05.

PCC Daily Submission Summary

This is a record showing that PCC has received your claims and sent them on to the clearinghouse or payor. The Billing History in the patient’s chart jumps directly to the correct segment of this report, but you can also review the full log in ecsreports. Your system receives the log within 48 hours of submitting claims. The report indicates that your connection to PCC was active and provides a “paper trail” proving that each claim passed through PCC’s central claim system. Your PCC system automatically parses this report and adds a note to each account history to indicate the claim was received by PCC, so under normal circumstances there is no need to review this report directly.

PCC CLEARINGHOUSE
DAILY SUBMISSION SUMMARY
FILE PROCESSING DATE: 03/11/2005
*******************************************************************************
030501021  BEDROCK PEDIATRIC PRACTICE      CLAIM BILLING DATE: 03/10/2005
*******************************************************************************
  PATIENT / CLAIM           PATIENT NAME             CLAIM        
     ID NUMBER          LAST            FIRST   MI FROM DATE     CHARGES
 ***************** ****************** ********** * **********    ********
AETNA HMO 15                       PAYOR ID: 60054
 243 10077         FLINTSTONE         PEBBLES      03/08/2005      111.00
AETNA EPO 10                       PAYOR ID: 60054
 394 10078         DOE                JOHNNY       03/08/2005      165.00
AETNA PPO 8                        PAYOR ID: 60054
 848 10079         CRUSHER            WESLEY       03/07/2005      111.00
AETNA POS 20                       PAYOR ID: 60054
 1068 10080        DUCK               LOUIE        03/08/2005       81.00
030501021   TOTAL                 CLAIMS:      4    CHARGES:       468.00

The above section shows that PCC received and processed four Aetna claims On March 10, 2005.

Payor Electronic Batch, Acknowledgement, Response, Summary, Rejection, Status, Unprocessed, and Exclusion Reports

PCC works to ensure that all claims route through the most efficient claim clearinghouse and reach the payor. In some cases, PCC builds a direct claim submission connection to a payor. As your claims travel from PCC, to a clearinghouse, and to a payor, the organizations involved send reports back to your practice. PCC parses these reports automatically and updates account histories. You can access specific replies in the Billing History section of a patient’s chart. The full reports are archived in ecsreports.

RelayHealth ebills Reports

If your practices uses a third-party bill printing service, you can review acknowledgements and other reports in the ecsreports tool. The provider of these services was originally known as RelayHealth, but has since been named and renamed Diamond and OSG. The reports your practice may receive from OSG include:

File Receipt Report: OSG’s acknowledgement of receiving an ebills submission file from your practice’s system.
Remote Statement Processing File Summary: OSG’s report of the total number of accounts, pages, and returns generated for a given ebills submission.
Suggested Address Correction Report: An error report sent by OSG when an address needs to be changed. In some cases, OSG will correct the address automatically, or it may indicate that a bill was “marked by USPS as unsuitable for delivery of mail.”

Here are some related articles in Billing and Practice Management > Bill Insurance:

Work on Claim Errors and Rejections
After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.
New User Training for Billers
Use this new user training outline to learn how to complete billing tasks in PCC.
The Claim Journey Explained
How is a claim created, and what happens in the background to make sure your practice is paid? Read below to learn some of the "under the hood" workings of claims after you post charges into PCC EHR.
Read EDI Responses to Claim Submissions
Your practices receives many different electronic responses to claim submissions and billing. Read this article to learn the different EDI responses, which responses require attention, and how to use PCC's tools to review and respond.
Submit Claims
Use the Claims tool to process and submit claims to insurance companies and other payers, work on claims that could not be submitted, and review a log of submissions.
Insurance Billing Overview
PCC's insurance billing tools help you process and prepare claims, send them electronically or print them, review rejections and denials, fix problems and resubmit, and work down your insurance accounts receivable. You can maximize the use of your time as you pursue proper insurance reimbursement.
Print Paper HCFA Claim Forms
While most claims are transmitted to payors electronically, sometimes you may need to generate a paper 1500 HCFA form.
Submit Claims
Prepare and submit claims. Then work on any claims that were stuck and couldn't be submitted.
Configure Claim Holds and Claim Delay
Watch this video to learn how to hold claims for specific providers, locations, or plans and how to configure your practice's claim delay.
Configure Claim Holds and Claim Delay
When your practice needs to prevent certain claims from being submitted, you can create a claim hold. A claim hold prevents claims from going out for specific dates of service, billing providers, places of service, and insurance plans. You can also configure your practice’s claim delay, which prevents any claim from going out until a certain number of days after the date of service.
Claim Error Needs Correction Reference
What kinds of pre-submission processing does your PCC system do on claims? What errors can it find, and how do you fix them?