Managing refused claims (PEI)

Reconciliation

Updated over a week ago

Once you have submitted your claims to HPEI, your billing items are validated before they process the claims and make payment.

If any of your bills are rejected HPEI sends them back with a status of Attention required: Refused so you can correct errors and resubmit the bills for payment.

Every morning you can see claim updates in the CHR from Health PEI (HPEI). The best way to keep track of your submitted claims is through the Billing dashboard to ensure that you address any claims that require your attention.

The most common claims you must keep track of and action are those with the claim status: Attention required and Cancelled.

You also want to keep track of claims with status Submitted. If a claim has a Submitted status for an extended period of time, contact Health PEI.

Steps

  1. From the main menu, click Billing.

  2. To see all claims with status Attention Required, filter the Billing dashboard by:

    • Status: Attention Required

    • Insurer: Health PEI

    • Applicable Service Date

    • Billing Practitioner(s)

    • Location(s)


    A billing report appears.

  3. Click the bill.
    📌 Note: When you select the patient name, the chart opens.

    The Edit Insured Payment window appears.

    💡 Tip: You can also create an appeal form for refused bills to send to Medicare.

  4. Read the Messages, e.g. unable to locate the fee code, and fix the error by clicking on the specific area of the bill and modifying it.

    📌 Note: if the Error Message reads Please select a billing provider and try again, this might indicate that you are not yet integrated with Health PEI. Contact the TELUS Health support team via the in-app support bubble.

  5. Once fixed, at the top of the bill next to Status select Ready to Submit.

  6. Click Save.
    The bill is re-submitted to HPEI.

Created: December 22, 2021


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