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.

7. Click Save. A Medicare Claim Appeal Form PDF appears.

You can save the PDF and send it to Medicare.

Updated December 07, 2022

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