Affinity Health Plan

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  • Emdeon Reports

    Several reports are available to you from Emdeon to reconcile your claim submissions, and identify rejected claims for correction and re-submission. The Emdeon Claim Submitter Reports Reference Guide includes samples and descriptions of key fields on each report. If you need assistance in receiving these reports, or you have problems reading the reports you are receiving, please contact Emdeon Customer Solutions at 1-800-845-6592.

    Ref# Report Name Description
    R020 Daily Management Summary A one-page provider report listing the number of claims received and the total claim charges for that day's submission.
    R021 Submitter Daily Summary Shows the number of claims accepted and rejected in a submission. If the file is accepted, month-to-date and year-to-date statistics are also listed.
    R022 Provider Daily Statistics This report contains totals of claims submitted, accepted and rejected, by batch, for each provider. Rejected batches and rejected claims are listed with detailed error explanations. These are claims that were not forwarded to the health insurance payer. Note: the most common errors include Provider ID and Member ID errors. Provider ID and Member ID may often be required, and Emdeon edits to ensure that, at a minimum, the format of these data elements is consistent with payer requirements. Claims appearing on this report should be corrected and re-submitted electronically as soon as possible to avoid filing issues.
    R023 Provider Daily Summary Shows the number of accepted claims per batch. Also contains a provider totals section that shows all input, accepted, and rejected statistics for that day, month-to-date, and year-to-date.
    R02 Daily Acceptance Report by Provider This report shows the claims Emdeon accepted and forwarded to the payer for additional payer editing and processing. Claims can pass clearinghouse edits, be displayed on the Initial Accept Report, but still be rejected by the payer.
    R027 Submitter Monthly Summary Contains the number of claims input, accepted and rejected for each provider, including month-to-date and year-to-date claim totals and statistics.
    R028 Provider Monthly Summary Contains the number of accepted claims sent to the payer with month-to-date and year-to-date statistics.
    R059 Unprocessed Claims Report Identifies claims rejected by the payer. A claim that is filed and rejected is not considered "received" by the payer. These claims should be corrected and re-submitted electronically as soon as possible to avoid filing issues.