The EDI 835 module allows your agency’s billing personnel to automatically reconcile payments remitted by Funders in Penelope.
Automated reconciliation of EDI 835 claims can significantly reduce manual data entry and user errors. In addition to streamlining your agency’s claims process, you will also have:
More information about processed records (including the logic applied in reconciliation)
Access to excluded records
Access to error records
EMS Power Reader
The EMS Power Reader (used to create the file uploaded into Penelope) allows you to:
View claim information prior to processing
Access additional reports
Have a better insight into claims
Processing an EDI 835 Claim
You will need to be logged into Penelope with an account that has sufficient permissions to process an EDI 835 file. Follow the steps below to process an EDI 835 claim:
Navigate to your My Home page.
In the Links sidebar click Process EDI 835.
Upload the EDI 835 file that you created in EMS Power Reader.
In the Receipt Details section select Create and Apply Credits for Remaining Amounts (e.g. will clear remaining balances) or Create Debits for Remaining Amounts (e.g. will create an invoice for the client to pay).
You will now see the Process Summary. Ensure Download CSV with results when “Finish is clicked is checked. This file allows you to review the results and fix any errors accordingly. We highly recommend you check this box as this is the only time the file is available.
Troubleshooting Issues and Errors
Issue 1: Ensure when uploading the file that it does not have any additional columns at start or end of it. This can result in the user receiving errors when attempting to process the file.
Solution for Issue 1: Re-download the file. Verify that it only has the expected columns and then upload it again.
Expected columns – Date of ServiceDate of ServicePatient Control NumberLine ChargedLine Date of Service Line Paid Line Allowed Amount Line Adj – Contractual Line Adj – Patient Line Adj – Payer Line Adj – Other Line Adj – Correction Check/EFT Date Check/EFT Trace Number Claim Status Claim Status Code Line Adj – Contractual Reason Line Adj – Correction Reason Line Adj – Other Reason Line Adj – Patient Reason Line Adj – Payer Reason Line Item Control Number Production Date
Issue 2: The file was saved in the ‘archive’ file and then attempted to be uploaded.
Solution for Issue 2: Re-download the file and ensure it is NOT saved in the archive file. Then upload it again.
For more information or if you have any questions regarding processing EDI 835 claims, please contact the Penelope Support Team. Please note that this is for US users only.