The TELUS Collaborative Health Record (CHR) uses statuses to indicate where in the billing process your claim is currently saved. There are statuses that apply before and after your claim has been submitted to Health PEI, and statuses that appear when a claim is returned from Health PEI.
Below is a summary of the PEI billing statuses for claims and billing items that you can see and use when you create and submit claims.
When you create a claim in the CHR, the default claim status is either Draft or Ready. See Changing the default billing status for your account for more information.
The bill is saved in the CHR.
You can make changes to the bill.
When the claim is ready to be submitted to Health PEI, you must manually change the status of the claim to Ready to Submit.
Ready To Submit
The bill is complete (ready) and once saved without errors, it is automatically submitted to Health PEI at the end of the day at 6pm.
The claim status then changes to Submitted.
⚠️ Important: Your claim will not be submitted to Health PEI until the encounter is signed.
Attention Required - with Invalid billing item status
When a bill is saved with status Ready to Submit, and the created bill cannot be submitted to Health PEI (e.g due to a missing diagnosis code, the provider is not integrated with Health PEI, the health card number is invalid), the status changes to Attention Required - Invalid.
As soon as your claim is successfully sent to Health PEI, the status changes to Submitted.
📌 Note: You cannot change this status.
Once a claim is submitted to the Health PEI, it comes back with a status of either Completed or Attention Required:
The claim was paid in full by Health PEI.
Attention Required - with Refused billing item status
The claim was returned in error. You must fix it and then re-submit it to Health PEI. See Managing refused claims.
Alternatively, create an appeal form and fax to Medicare Appeals.
Attention Required - with Adjusted billing item status
The claim was returned and was overpaid or underpaid. You cannot make any changes to the bill or the status. You can however appeal this. See Submitting appeals to Medicare.
The claim was returned and was not paid at all. You cannot make any changes to the bill or the status. You can however appeal this. See Submitting appeals to Medicare.
Updated October 16, 2023