Affinity Health Plan EDI Reports via Emdeon Clearinghouse
Affinity Health Plan EDI reports are available to Affinity Health Plan EDI partners from Emdeon to reconcile the claim submissions, and identify rejected claims for correction and re-submission. The basic types of Affinity Health Plan EDI reports sent via Emdeon Clearinghouse are given below.
Affinity Health Plan EDI Reports
| 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. |