Review Archived Claim Response Files and Other EDI Reports

• See 5 Related Articles
• Share this article

After you submit claims, your practice will receive claim errors, denials, acknowledgments, exclusions, and other electronic notifications from payers and claim clearinghouses.

You can use PCC tools to review these responses. You can also see them in an account’s history in Correct Mistakes (oops), and from there jump directly into the relevant section of the electronic response.

When you need to do deeper research, however, you can use the EDI Reports (ecsreports) program, which holds a library of all “Electronic Data Interchange” reports sent to your practice. In addition to the full payer responses, you can use ecsreports to see which batches your practice sent, bad claims that need correction, daily acknowledgements from payers/clearinghouses, and e-bill confirmations.

Read below to how to use the EDI Reports program.

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 Open EDI Reports and Review the List of Reports
• 2 Open and Read a Report
• 3 Print an EDI Report
• 4 Find EDI Reports by Type
• 5 Search Multiple EDI Reports
• 6 Search Reports You Are Viewing
• 7 Examples of EDI Reports

Open EDI Reports and Review the List of Reports

Open the ecsreports program from the Electronic Claims section of the Billing Functions window in your Practice Management window.

Reports are grouped together by the date they were received, with the most recent delivery date appearing at the top. 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, either from the main screen or from one of the “By Type” listings in ecsreports, and press F1 – View Selected to read it:

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

While viewing a report or multiple reports, you can press Page Up or Page Down to scroll. Press the End key to jump to the bottom of the report(s), press Home to jump to the top.

Find EDI Reports by Type

Press F8 – List By Type in the ecsreports program to see reports grouped by type. The “By Report Type” screen displays all report types stored on your system.

To access all available reports of a certain type, select the type and press F1 – Select Type.

Reading and searching through a specific report type may be more convenient than viewing all the reports from a specific date.

Press F12 to return to the listing by date.

Search Multiple EDI Reports

You may need to search through multiple reports for a name, certificate number, or other identifier. You might not have any idea in which report the information is located, or on what date you received the information. ecsreports has a robust search engine that allows you to search through reports in several different ways.

Search Reports You Are Viewing

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.

Examples of 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 clearing-house or payor. You should receive this log within 48 hours of submitting claims, and it is stored in ecsreports. This 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.

Various Claim Verification, 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. In most cases, you would not need to read a full report file, but they are archived in ecsreports.