Which EDI Reports Should You Review?

PCC, claim clearinghouses, and carriers all send EDI reports. How do you know which reports are important to review, and which reports are merely for reference purposes?

  • Some reports list claim errors or problems that must be dealt with before you can receive reimbursement.

  • Eligibility reports tell you the insurance status of scheduled patients before they come in for their visits.

  • ERAs contain payment information and need to be posted against a balance in the Post Insurance Payment (pip) program.

  • Some reports are for reference, useful for tracking claims or understanding your office’s overall claim activity.

Claim Reports: This chart shows the reports sent to a typical office as an insurance claim is processed and submitted:

While all of the EDI reports you receive contain useful information, the tables below show you which reports contain vital information that you must follow-up on and which reports are only references for later use.

Essential Reports

The reports in the tables below contain vital information, such as claim errors, rejections, or payment information. You should review the reports listed below as you receive them.

You Do Not Receive All of These Reports!: Different offices receive different reports, based on their region and their carriers. The tables below list all reports that contain essential information, and PCC EDI Support can help you further identify which reports are important for your office.

Table 1. Essential General Reports

Report TitleReport CategoryWhy Does It Matter?
preptags/tagsplit Bad ClaimsElectronic ClaimsLists claims Partner did not process
Eligibility ReportInsurance EligibilityLists insurance eligibility data for scheduled patients
ERA/EOB ReportERA/EOBContains remittance information

Table 2. Essential Capario (ProxyMed/MedAvant) Reports

Report TitleReport CategoryWhy Does It Matter?
Capario (ProxyMed) Daily Verification ReportElectronic ClaimsIncludes claim errors
Capario (ProxyMed) Payor Response ReportElectronic ClaimsIncludes claim errors

Table 3. Essential RelayHealth (McKesson) Reports

Report TitleReport CategoryWhy Does It Matter?
McKesson Carrier AcknowledgementElectronic ClaimsIncludes claim errors
McKesson Exclusion ClaimsElectronic ClaimsIncludes claim errors
McKesson RemittanceEOB/ERAContains remittance information
McKesson System RejectElectronic ClaimsIncludes claim errors
McKesson Address ReportE-BillsLists electronic personal bills that require attention
McKesson ebills ReportE-BillsLists electronic personal bills that require attention

Table 4. Essential Emdeon (ENVOY/WebMD) Reports

Report TitleReport CategoryWhy Does It Matter?
Batch & Claim Level Rejection ReportElectronic ClaimsIncludes claim errors
Special Handling/Unprocessed Claim ReportElectronic ClaimsIncludes claim errors

Table 5. Other Essential Insurance Claim Reports

Report TitleReport CategoryWhy Does It Matter?
Availity Electronic Batch ReportElectronic ClaimsIncludes claim errors
Availity Delayed Payor ReportElectronic ClaimsIncludes claim errors
Highmark Submission AnalysisElectronic ClaimsIncludes claim errors
Anthem Midwest Clearinghouse ReportElectronic ClaimsIncludes claim errors
VT BCBS ECS Audit ReportElectronic ClaimsIncludes claim errors
TN BCBS Receipts Confirmation ReportElectronic ClaimsIncludes claim errors
VT Medicaid Claim Accept/Reject ReportElectronic ClaimsIncludes claim errors
RI BCBS Batch Control ReportElectronic ClaimsIncludes claim errors
RI BCBS Rejected Claims Error ReportElectronic ClaimsIncludes claim errors

Reference Reports

The reports in the table below are not essential. They contain summaries and totals, claim logs, and other information that may be a useful reference later.

Report TitleReport CategoryWhy Does It Matter?
ECS Batch LogElectronic ClaimsLists all claims sent out from Partner
PCC Daily Submission SummaryElectronic ClaimsContains PCC’s confirmation of claim receipt
RelayHealth (McKesson) Claims AcknowledgementElectronic ClaimsContains a record of all claims RelayHealth received during a particular submission
RelayHealth (McKesson) Monthly SummaryElectronic ClaimsContains a summary of a month’s claim activity with RelayHealth
Emdeon Claim Status ReportElectronic ClaimsIncludes claim errors and acceptances, as well as denials.
Emdeon File Detail Summary ReportElectronic ClaimsShows rejected claims

  • Last modified: January 2, 2019