How to fix a rejected Out Of Province claim:
To fix a rejected out of province claim is a two-step process. First update the patient record and then reload the patient information into the invoice.
To do so, follow these two steps:
1. Update the patient's details under your 'Manage Patients' menu.
The required fields for out of province claims are:
- First name, last name
- Healthcare Type (province patient is from)
- Health Number (out of province health card # - enter in Health and Service Information section - see screenshot)
- Date of Birth
- Full Address - address line 1, city, province, and postal code.
Then click the blue “Update Patient” button to save.
2. Once this is done, edit the invoice in question and hit the 'reload' button next to the patient's name (attached image). This will add all the updated patient details into your invoice automatically.
First, under the 'Advanced' tab to set the “Insurer Type” to ‘Out Of Province’.
Second, under the 'Patient’ tab, enter the patient's out of province health card number in the “Registration Number” box at the top.
Lastly, on the ‘Patient’ tab fill in the patients “Province” (province they are from), “Gender”, and full address including postal code.
Note: If the claim is over 90 days, it can be resubmitted with Submission Code C: "C - Post 90 day - Coverage Issue (Note required) (C)". Set the ‘Submission Code' to “C” on the ‘Advanced’ tab.