Insured claims can come back with a status of Cancelled or Adjusted. Health PEI has either rejected parts of the bill or the entire bill.

You can accept the reason for the cancelled claim or you can appeal the claims that have been cancelled or that need to be adjusted. Do not create a new claim unless instructed to do so by a Medicare assessor.

📌 Note: You cannot modify Cancelled or Adjusted bills.

Steps

  1. From the main menu, click Billing.

  2. To see all claims with status Cancelled and Adjusted, filter the Billing dashboard by:

    • Status: Attention Required and Adjusted

    • Insurer: Health PEI

    • Applicable Service Date

    • Billing Practitioner(s)

    • Location(s)

  3. Click the claim to view details.
    📌 Note: When you select the patient name, the chart opens.

    The Edit Insured Payment window appears.

  4. Click the information icon at the top-right corner of the billing items to view the Transaction Details:


    a. Document the 9-digit Claim #

    💡 Tip: If you don’t see the complete Claim #, move your mouse over the number and the full number is displayed.

    b. Document the reason for the appeal, fee codes and dollar amounts.

  5. Navigate to the CHR main menu and click Inbox.

  6. Click +Message in the top-right corner.
    The New Message window appears.


  7. Type the following:

    a. To: Medicare Appeals

    b. Title: Add a descriptive subject, e.g. Appeals for Dr. Test

    c. In the Text box: Type a message that includes the reason for appeal, claim number, rejection code, correct fee code and the expected bill outcome (amount to be paid)

  8. Click Submit.

    📌 Note: The Medicare Appeals group processes your request, create a report for each claim # and send it to your inbox.

  9. Wait for a message to appear in your inbox.

  10. Review the report, add any additional comments if required (e.g. reason for appeal) and fax the report to Medicare (902-838-0940)

Created December 22, 2021

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