ProxyMed Template
The ProxyMed template is the medical claims template used to upload claims to Change Healthcare (formerly Capario). eClaims sent to Change Healthcare can receive status updates in MacPractice in the form of eClaim reports. These reports will be automatically attached to claims whenever possible, and will subsequently move the claim to the correct status tab automatically. After sending claims, MacPractice will prompt the user to receive reports.
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Most reports will automatically tie to claims in MacPractice. They will be displayed in the claim status area when a claim is selected. Claims rejected by either the clearinghouse or the payer will be moved to the Rejected tab, and claims accepted by either will be moved to the Accepted tab. If reports are received daily, claims should only stay in the Sent tab for 24-48 hours. If claims remain in the Sent status for any longer, please contact MacPractice EDI support, at 877-220-8418, to troubleshoot any possible issues with the claim.
Accepted claims
Claims in the Accepted tab have either been accepted by the clearinghouse or the payer. All accepted claims can be viewed by selecting the Accepted tab. Select a claim to view the status updates below and to view the status update messages. When an eClaim report automatically moves the claim from one status to another, the status update message will say "via Auto Report Apply." This simply indicates that the user downloaded a report that changed the claim status. To be taken directly to the report under the Reports node, the user can click the “Reported from Payer” or the “Reported from Clearinghouse” link.
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It should be noted that a claim being in the Accepted tab does not necessarily mean the claim has been accepted for processing by the payer. Claims will have an accepted status once accepted by the clearinghouse, but not all payers will send status reports back. MacPractice has no control over the amount of information that is received from insurance companies, and any issues will have to be addressed with the payer.
Rejected claims
Claims in the Rejected status have either been rejected by the clearinghouse or the payer. Claims will stay in the Rejected status until they are fixed and resubmitted. The most recent rejection message will always be listed near the top, however all messages should be read carefully. Some claims will be rejected because of multiple problems and each problem is usually listed separately.
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To rebuild a claim, select the claim in the eClaims table and click the Rebuild button. When rebuilding, MacPractice will check for any updated information for the patient, and fetch that updated information on the claim. As long as the claim then passes MacPractice validation, it will be moved back to the Ready status for resubmission. If it does not pass MacPractice validation it will be moved back to the Invalid status.
'Some rejection messages may be rather cryptic, especially rejection messages from payers. MacPractice has compiled a list of some of the most common rejection messages.
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Many are articles in the eClaims Ability.
For assistance with rejected eClaims, please contact the EDI division of the MacPractice support department at 877-220-8418. Please provide the 15-digit trace number listed above the rejection message. Alternatively, the trace number can be clicked in order to submit a ticket to MacPractice that already contains the trace number. Please only submit one ticket for each rejection type.
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