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 |