⚠️ Important: This is currently a beta feature. It will be available once the beta period is complete.
Before submitting a claim to New Brunswick Medicare for assessment, you can send a request to Medicare Claims Entry (MCE) for validation only.
When you submit a claim for validation, a response is returned immediately with one of these statuses: Predetermination Accepted or Predetermination Rejected. Predetermination statuses are available when filtering the billing dashboard.
💡Tip: We recommend you send your first few claims for predetermination to provide general confirmation that the claim submission is working correctly.
Steps
Create a new bill from:
The Visits dashboard
The Insured billing section of the patient's chart
📌 Note: If you created the bill from an encounter and the bill status is Draft, you must first sign the encounter before you can submit it from the Insured billing section of the patient's chart.
The New or Edit Insured Payments window opens.
2. Modify the billing item fields. For more information, refer to Modifying a provincial bill's billing practitioner, location, specialty and other information.
3. In the payment details section, set the Predetermination field to Yes.
4. To add a billing item (service code) to the bill, click +Add Fee Item. Refer to Adding and modifying billing items (service codes) to provincial bills (New Brunswick).
5. At the top of the window, change the status to Ready to Submit.
📌Note: This status remains until the predetermination status is returned from Medicare Claims Entry (MCE).
6. Click Save to send the claim to Medicare Claims Entry (MCE) for validation.
7. When you submit a validation claim, a response is returned immediately. Refer to the below table for a detailed description of the status:
Status | Description |
Predetermination Accepted - with a Pred billing item status.
| 
The validation claim is returned without warnings.
The Predetermination field automatically changes to No.
Change the billing status to Ready to Submit and proceed with submitting the claim.
💡Tip: You can filter predetermination statuses in the billing dashboard and update multiple Predetermination Accepted claims to Ready to Submit at once. Refer to Bulk changing the status of insured claims for more information. |
Predetermination Rejected - with a Refused billing item status.
| 
The validation claim is returned with warnings related to one of the fee items in the claim.
Alternatively, you can leave the field as is and re-submit for Predetermination. |
Predetermination Rejected - with a mixed billing item status.
| 
The validation claim is returned with warnings for multiple fee items in the claim.
Alternatively, you can leave the field as is and re-submit for Predetermination.
📌Note: The Pred fee item remains in Ready status and the payment remains in Submitted status until the fee item status is updated. |
8. If there are no further errors or warnings, you can proceed with submitting the claim. Refer to Reviewing and submitting provincial bills to New Brunswick Medicare.
📌Note: If the validation claim is no longer needed, click the trash can icon to delete.
Updated September 9, 2024