Submitting appeals to Medicare (PEI)

Reconciliation

Updated over a week ago

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.

📌 Note: You cannot modify Cancelled or Adjusted bills.

⚠️ Important: Do not create a new claim unless instructed to do so by a Medicare assessor.

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 Cancelled

  • Insurer: Health PEI

  • Service Date: Set the service date range for which you want to view bills.
    💡 Tip: To filter bills by paid date, in the Search By list, select Paid Date.

  • Billing Practitioner: Select the providers for which you want to view bills.

  • Location: If your clinic has multiple locations, select the locations for which you want to view bills.

3. Click Apply. A list of bills displays.

4. To open a claim, click the description

💡 Tip: Clicking a patient's name opens their chart instead of the bill.

5. In the the Edit Insured Payment window, click the Prepare Appeals form (printer) icon.

6. In the PDF Settings window that opens, input information as follows:

  • Cover Page (optional): Select a cover page from the list to add to the appeal form. To learn more, go to Creating cover page templates.

  • Reason for Appeal: Type the reason.

📌 Note: The help text assists with what to include in your appeal.

7. Click Save.

A Medicare Claim Appeal Form PDF appears.

📌 Note: The provider’s name is included on the appeal form even if an MOA generates it. Additionally, a claim’s start time, if entered, is also included on the appeal form.

8. Fax the PDF to Medicare:

a. Click the fax icon.

b. A new window appears, where you can specify the recipient.

c. If Medicare Appeals is stored in your Contacts, search for it and select, or manually type the fax number 902-838-0940.

d. Click Send.

📌 Note: The Medicare Appeals group processes your request, creates a report for each claim number, and sends it to your inbox.

Updated October 16, 2023

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