EDI Medical Bills Acceptance And Rejection by Florida Division of Workers’ Compensation
EDI Medical Bills may have the following statuses: Acceptance, Acceptance with Error, Rejection, Not Processed, Withdrawal, Correction, Replacement.
When submitting corrections for rejections, replacements (amended/readjusted/data cleanup), or withdrawals, use the same Control Number that was used in the original submission of the medical bill. Submitted medical bills containing no rejection errors for any data elements will be accepted by the Medical Data Management System. Submitted medical bills containing rejection errors for any data element will result in rejection of the entire bill.
Upon completion of processing the submitted file, a Medical Bill Acknowledgement will be placed in two formats, (PDF and Acknowledgement flat file), in the “outgoing” folder of the Sender’s SSH (SFTP) mailbox. The Sender will be notified via email when the Acknowledgement reports are completed and available for pickup. The PDF version summarizes the number of medical bills submitted, accepted, accepted with errors, not processed, withdrawn, and rejected in the transmission. This report also lists each medical bill submitted, its status as accepted, accepted with errors, not processed, withdrawn, or rejected, and any applicable errors. The Acknowledgement flat file contains the same information as the PDF file in a computer-readable fixedcolumn format. After receiving this report, the Sender shall verify that all of the data in the transmission have been accurately accounted for on the report and investigate any errors.
All medical bills with errors must then be re-submitted to the Division with necessary corrections, using the same Control Number as the original medical bill with errors. The original submission, the re-submission of rejected medical bills, and the replacement of previously accepted medical bills must be in compliance with Rule 69L-7.750, F.A.C. Data are not considered “filed with the Division”’ until they have been accepted by the Division.
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