How to Manage Rejections
Juvonno will be parsing the remittance into Juvonno for you.
Once the remittance has been parsed you will be able to check the Rejections Report which indicates the Rejection Codes and provides the EOB.
You are able to edit some of the rejected claims.
You may have to create some as a New claim.
You may be be able to set some claims back to "New", edit the claim and it will go to MB Health in the next submission.
This depends on the rejection code.
Where to access Rejected claim information
From the Rejection and Abnormal Payments Report
From the Home page, under the Reports section select Rejections and Abnormal Payments.
The report search page will open.
Select the date range you want to create the report for based on the last remittance dates.
Select if you want to create the report in a Detail or Summary version.
This report will list all the details including the Rejection codes for each claim.
From the Appointment Claims Link
From the Home page under the Claims section select the Appointment Claims link.
The Appointment Claim Search page will open.
Select the date range based on the last submission.
Set the "Status" field to "Rejected" then Search.
At the bottom of the page all the rejected claims will be listed.
Patient Profile Warning
If there is an error in the Patient Profile you will see a triangular warning icon to the left of the claim #. Hover on the warning, it will indicate what is missing in the patient profile.
The example below indicates the Patient Health Care # is missing.
In these cases you will have to open the patient profile, add the health care # and save. Then create a new claim.
How to View the Claim to locate the EOB and Rejection/Disposal Codes
Click the icon to the left of the claim item you want to view and select "Open Claim".
On the far right side of the claim popup under the EOB and Disposal codes section, the Tariff, Code and Description will be displayed.
How to Edit a rejected claim
In some claims you will see the "Edit"option at the top of claim popup as seen in the image below.
You may also see the "Resubmit" button as seen in the image below.
This button is located in the bottom right corner of the claim popup.
In this instance you are able to Edit and Resubmit the claim from this claim page and it will be submitted in the next submission.
An Example of this type of claim is for rejection Code 44. It allows you to both edit and resubmit.
When you have to create a New Claim
If you do not see the "Edit" and the "Resubmit" buttons you will have to create a new claim if the Rejection code description tells you to "Create a new claim".
How to set a claim Status back to New
From the Home page go to the "Appointment Claims" link.
The Appointment Claims Search page will open.
Set the date range based on the remittance dates.
Set the status field to "Rejected".
Click the icon to the left of the claim item. Select "Update" Status option.
Next to the "New Status" field select "Receivable (New").
This puts the claim back to "New" and will be submitted again in the next submission.
Now go to back to the Home Page and select the "Appointment Claims" link again.
Set the date parameters and set the "Status" field to "New".
Locate the claim you want to open and edit. Click the icon to the left of the claim item, select "Open Claim", edit details that are required and Save.
The claim will be sent in the next submission.
Start and End Times Rejections
Claims rejected due to the Start Time was Blank or Invalid, will be rejected if those fields are not correct or blank.
Follow the steps to set the claim back to "New" unless the Rejection Code states create a new claim.
Examples of some Rejection Codes Desciptions
Rejection code C7
If the appointment is not being performed out of a "Hospital" such as a Centre or a Clinic, leave the Claim Type Field in the claim you are creating set to "Blank".
Rejection Code B9
Rejection Code 2S
You must have the correct Facility selected for the type of service and where in the Hospital it was performed.
Example: Tariff 8526
You must select the correct Facility as listed below in the claim "Hospital" field.
CTU Ward A Facility #396 St Boniface General Hospital
CTU Ward B Facility # 397 St. Boniface General Hospital
CTU Facility # 188 St. Boniface Family Medicine
CTU Facility # 389 St. Boniface Cardiology