When you submit claims to Health PEI, some incorrect bills may be refused. When a claim is rejected, the CHR flags the associated bill as Attention Required. The CHR can also identify an issue with a bill prior to submission and automatically flag it as Attention Required.
When managing a refused status bill, you can create an appeal form directly from it. This helps to generate a standardized appeal form along with the reason.
Steps
1. From the main menu, click Billing. The Billing dashboard opens with a list of bills created today.
2. To see all claims with the Attention Required status, filter the Billing dashboard by:
Status: Attention Required
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.
⚠️ Important: You can create an appeal form for bills with a Refused or Cancelled status.
4. To open a bill, click its description.
💡 Tip: Clicking a patient's name opens their chart instead of the bill.
5. 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.
You can save the PDF and send it to Medicare.
📌 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.
Updated February 17, 2023