Read Medi-Cal's reports

Reading a report changes the status of your claims, so it is for owners, managers and anyone who has been given Approve claims for a file in the staff permissions. Anyone else sees “You do not have permission to read Medi-Cal replies at this clinic. Ask an owner or manager.” After you upload a file, Medi-Cal sends reports back. Reports reads them for you: you drop in the report you downloaded from the Medi-Cal Provider Portal, and each claim shows what happened to it, in plain words. Reading a report can also move your claims from In a file to Accepted, Rejected, Paid or Denied.

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What to upload

The screen accepts .pdf, .txt, .835, .999, .277, .277ca, .edi and .dat files up to 20 MB. ClinikEHR works out which kind a file is from the file itself. Add one report at a time.

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Read a report

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Read the results

Each line has a badge and a sentence: Select Open claim on a line to go to the claim. On a rejected claim, Fix and re-file opens the same claim; see Corrected claims and voids.

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When a report names only one claim

Medi-Cal lists each error once, however many claims had it. When that happens the line says “Medi-Cal found this on N claims and names only the first.” ClinikEHR can match only the first claim. It never guesses at the rest: open the others and check them against the report.

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The 999 and the 277CA

These are acknowledgements, not payments. A 999 says whether a whole file was accepted or rejected, so every claim in the file you chose moves together to Accepted or Rejected. If the 999 names a different file than the one you chose, or says only part of the file was accepted without saying which claims, nothing changes and the sheet says so. A 277CA answers claim by claim: your account number in box 26 matches each line to a claim, and the claim moves to Accepted or Rejected. A status that is neither, such as “not found”, is shown as a Note and moves nothing. Medi-Cal’s own guide lists neither report for a file sent straight to Medi-Cal, so you will see them only if your clearinghouse sends them. ClinikEHR has not yet been checked against a real 999 or 277CA, so compare what you see with the original until the note on the results sheet is gone. A claim turned away by a 999 can be re-filed free, once, like one turned away by an Error report or Volser Summary (see Corrected claims and voids). A claim turned away by a 277CA is re-filed from the claim as usual, but the copy is charged.

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Lines that are not matched to a claim

Some lines are not matched to any claim here. That is normal on a payment advice: it also covers paper claims and claims from other submitters. A line says why it was not matched. ClinikEHR matches by the claim control number, then by your account number in box 26, narrowed by the charge and the first date of service, and by position in the file for an error report. It never matches by patient name, and when it cannot tell which claim, it leaves the line unmatched.

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What changes on your claims

• A claim that is In a file moves to Accepted, Rejected, Paid or Denied when a report says so. An Accepted claim can later move to Rejected, Paid or Denied.
• A claim that is a draft, ready or approved is never moved, so a test file’s reply does not touch a claim that is not in a production file.
• A Rejected claim is not moved again by a later report.
• A report that cannot be tied to your claims with confidence is stored and the statuses are left alone. The sheet says so.

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The 835 payment view

For a payment advice the results show four figures: Paid, Billed on these claims, Paid in full or in part and Denied. Select Export CSV to download the lines as a spreadsheet. The Paid tile on the claims home adds up the payments matched to your claims, and shows a dash until you have imported one.

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Reports and results through Ozni

Attach a Medi-Cal report in a chat with Ozni and ask it to read it: a PDF (the Volser Summary or the Error report), or an electronic file (an 835 payment advice, a 999 or a 277CA). Ozni never shows the content of an electronic file in the chat; it is read by the same reader as this screen. An 835 or a 277CA needs no file chosen: each line is matched to a claim by your account number, the card says what will be read, and the counts come back in plain words. If nothing in it matches one of your claims, Ozni says so and no claim changes. A PDF report and a 999 are matched to the Medi-Cal file it answers, so Ozni asks which of your recent files it is for (it lists them by day, test or production, and number of claims), or uses it when you have only one. The card names that file. When you confirm, the report is read and each result is matched to the claims in that file, with the counts in plain words. It needs the same permission as this screen, and reading the report uses no agent credits (a payer report attached to a chat is priced as an ordinary message; a PDF is a heavy request, see Attaching a file to a chat). If you have not made a file yet, a PDF report or a 999 has nothing to match to, so make the file first. Ozni can also give you the results as a download: ask for the CSV of a report and confirm the card.

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What is kept

The report file is deleted after 7 days. The results stay. ClinikEHR does not read a patient’s name from an 835.

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Check it worked

• The report appears in the list with the time it was read and how many claims it matched.
• Open a claim that was in the report. A card on the claim shows what Medi-Cal last said about it, with a link to See all reports.
• The claim’s status on the claims home matches the result.

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Common issues

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FAQ