EDI Release 3 - Common Problems
Post date: Dec 27, 2012 2:15:36 PM
Do not file a late reason on reports unless the jurisdiction requests it. The state of West Virginia rejects all reports (TR) with late reason codes and will not look at the rest of the report, the report may be correct but will not process solely based on the late reason code which only delays the report further.
All reports that receive a TE acceptance value (accepted with errors) must be refiled using a CO (correction) report after repairing the problem with the report. The jurisdiction will not accept any more reports until they receive a CO and they accept it with a TA value. To file a CO report - Right click on the report that received the TE acceptance value in the FROI or SROI history screen. The claim values that are missing or incorrect must be repaired and a CO report must be filed on the day that the results are loaded so there will be no delay in future reports.
If the last report that was filed is a AQ report (Acquired Claim) the next report that must be filed is an AP (Acquired Payment) report. All other reports will be rejected until the AP report is accepted. The AP report only needs to include the 440 (Total Prior Unallocated Medical Benefits) and the 430 (Total Prior Unallocated Indemnity Benefits) segments under the "Other Benefits" tab.
When acquiring a new company a AQ FROI report followed by a AP SROI report must be filed for each open and active claim. After the AQ and AP reports are accepted any other report can be filed for the claim. All other reports will be rejected until the AQ and AP reports are accepted.
When changing the claim administrator information a 02 FROI and 02 SROI report must be filed for each open and active claim. After the 02 reports are accepted any other report can be filed for the claim. All other reports will be rejected until the 02 reports are accepted.
All companies in a specific database must share a common claims administrator and EDI trading partner.