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 Title Report Category Why Does It Matter?
preptags/tagsplit Bad Claims Electronic Claims Lists claims Partner did not process
Eligibility Report Insurance Eligibility Lists insurance eligibility data for scheduled patients
ERA/EOB Report ERA/EOB Contains remittance information

Table 2. Essential Capario (ProxyMed/MedAvant) Reports

Report Title Report Category Why Does It Matter?
Capario (ProxyMed) Daily Verification Report Electronic Claims Includes claim errors
Capario (ProxyMed) Payor Response Report Electronic Claims Includes claim errors

Table 3. Essential RelayHealth (McKesson) Reports

Report Title Report Category Why Does It Matter?
McKesson Carrier Acknowledgement Electronic Claims Includes claim errors
McKesson Exclusion Claims Electronic Claims Includes claim errors
McKesson Remittance EOB/ERA Contains remittance information
McKesson System Reject Electronic Claims Includes claim errors
McKesson Address Report E-Bills Lists electronic personal bills that require attention
McKesson ebills Report E-Bills Lists electronic personal bills that require attention

Table 4. Essential Emdeon (ENVOY/WebMD) Reports

Report Title Report Category Why Does It Matter?
Batch & Claim Level Rejection Report Electronic Claims Includes claim errors
Special Handling/Unprocessed Claim Report Electronic Claims Includes claim errors

Table 5. Other Essential Insurance Claim Reports

Report Title Report Category Why Does It Matter?
Availity Electronic Batch Report Electronic Claims Includes claim errors
Availity Delayed Payor Report Electronic Claims Includes claim errors
Highmark Submission Analysis Electronic Claims Includes claim errors
Anthem Midwest Clearinghouse Report Electronic Claims Includes claim errors
VT BCBS ECS Audit Report Electronic Claims Includes claim errors
TN BCBS Receipts Confirmation Report Electronic Claims Includes claim errors
VT Medicaid Claim Accept/Reject Report Electronic Claims Includes claim errors
RI BCBS Batch Control Report Electronic Claims Includes claim errors
RI BCBS Rejected Claims Error Report Electronic Claims Includes 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 Title Report Category Why Does It Matter?
ECS Batch Log Electronic Claims Lists all claims sent out from Partner
PCC Daily Submission Summary Electronic Claims Contains PCC’s confirmation of claim receipt
RelayHealth (McKesson) Claims Acknowledgement Electronic Claims Contains a record of all claims RelayHealth received during a particular submission
RelayHealth (McKesson) Monthly Summary Electronic Claims Contains a summary of a month’s claim activity with RelayHealth
Emdeon Claim Status Report Electronic Claims Includes claim errors and acceptances, as well as denials.
Emdeon File Detail Summary Report Electronic Claims Shows rejected claims

  • Last modified: January 2, 2019