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CHR billing statuses (New Brunswick)
Updated over a week ago

⚠️ Important: This is currently a beta feature. It will be available once the beta period is complete.

The TELUS Collaborative Health Record (CHR) uses statuses to indicate where your claim currently is in the billing process. There are statuses that apply before and after your claim has been submitted to New Brunswick Medicare, and statuses that appear when a claim is returned after assessment from New Brunswick Medicare.

Before you submit a claim, you have the option to send the bill to the Medicare Claims Entry (MCE). For more information, refer to Submitting claims to Medicare Claims Entry (MCE) for predetermination.

Below is a summary of the New Brunswick billing statuses for claims and billing items you can see and use when creating and submitting claims.

When you create a claim in the CHR, the default claim status is either Draft or Ready. For more information, refer to Setting your default billing status.

Claim Status

Description

Draft

The bill is saved in the CHR. You can make changes to the bill.

When the claim is ready to be submitted to New Brunswick Medicare, you must manually change its status to Ready to Submit.

Ready To Submit

The bill is complete (ready) and once saved without errors, it is automatically and immediately submitted to New Brunswick Medicare.

The claim status changes to Submitted.

⚠️ Important: Your claim will not be submitted to New Brunswick Medicare until the encounter is signed.

Attention Required - with a Refused billing item status

When a bill is saved with the status Ready to Submit, and the created bill cannot be submitted to New Brunswick Medicare (e.g. diagnosis code is missing, the provider is not integrated with the Medicare Claims Entry (MCE) web service, the health card is invalid), the status changes to Attention Required - Refused.

Submitted

Once your claim is successfully sent to the Medicare Claims Entry (MCE) web service, the status changes to Submitted.

📌 Note: You cannot change this status or edit the bill at this point.

Once the claim is processed, it is returned with a status of either Submitted or Attention Required.

Submitted

The claim stays in Submitted status until the reconciliation file is received and processed.

Attention Required - with a Refused billing item status.

The claim is returned due to an error. You must fix it and resubmit it to New Brunswick Medicare, or delete it. Refer to Managing refused claims.

After receiving the reconciliation report from Medicare Claims Entry (MCE), the CHR claim and fee item statuses are updated as outlined in the table below:

Status

Description

Paid - with a Paid billing item status

The submitted claim was accepted and paid in full by New Brunswick Medicare.

Attention required - with an Adjusted billing item status

The submitted claim was previously paid in full by New Brunswick Medicare and then reversed.

📌Note: You cannot edit the fee item, only change the payment status to Completed.

Attention Required - with an Adjusted billing item status

The submitted claim was accepted and paid in full by New Brunswick Medicare and then adjusted.

📌Note: You cannot edit the fee item, only change the payment status to Completed.

Attention required - with a Cancelled billing item status

The claim was returned and was not paid at all. You cannot make any changes to the bill or the status.

⚠️Important: When a claim is rejected at the reconciliation step, the claim cannot be resubmitted and you must create a new claim. Refer to Duplicating a fee item on a bill for more information.

Updated September 13, 2024

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