HearAid Version 5.0

Reconcile

Reconcile

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Reconcile

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HearAid's electronic claim reconciliation provides users with a powerful tool for keeping on top of e-claims. Response files are Zip files which contain three text files: ACCEPT.TXT, REJECT.TXT and SUMMARY.TXT and they must always be downloaded and saved into the ..\EClaims folder specified in Tools|Options|Database & Analysis|e-Claim Folder

 

The Toolbar:

ReconcileToolbar

 

Reconcile Claims processes the selected response file
Update Response File List refreshes the list of response files. Click this button if the Reconcile work-area was open while response files were downloaded from the Medicare web site
Print Claim List prints the list of claims processed in the Response File

 

The Work Area:

Reconcile

 

To Reconcile a batch

1.Click on the Response File Name in the list
2.Click the Reconcile Claims button on the toolbar

 

The Reconciliation processing

1.Extracts ACCEPT.TXT, REJECT.TXT and SUMMARY.TXT from the Zip file and their contents can be viewed on the Accept.txt, Reject.txt, Summary.txt tabs respectively. The original batch file is also shown on the Batch Record tab
2.Reads the Accepted list, finds each claim item in the list, clears the Processing flag and marks it as Paid
3.Reads the Rejected list, finds each claim, clears the Processing flag and stores the error message with the claim
4.Reads the Summary and stores the Payment Amounts and Payment Due in the Batch Log record for that batch

 

Accepted claims are shown with a green background

 

Rejected claims have a pale yellow background and the description of the reason for rejection is clearly displayed

 

Missing claims and clients have an orange background. HearAid 5.0 will automatically recreate missing clients and claims as part of the reconciliation process

 

- A claim will be listed as missing if the program cannot find a claim which matches item number, service date and client number. Recreated claims will have UNKNOWN in Site, Practitioner and Authorised Person fields

 

- A client will be listed as missing if the program cannot find a client with a matching OHS number (excluding the voucher date part of the number). Missing clients that are recreated will be given the Family name **UNKNOWN CLIENT** and Given name **Recreated**

 

Recreated records should be traced and corrected immediately!

Once the reconciliation has completed, click on Accepted or Rejected in the Program Navigator to display the lists of accepted and rejected items for the batch
If you cannot see a response file for a batch it is most likely that the file was downloaded and saved to the wrong folder