PPM Software Ltd
EDI setup and usage notes version 4.14g onwards
EDI Setup
EDI Setup Details need to be added
Go to Setup and Maintenance, External Applications, EDI Setup
The details provided by Healthcode need to be entered here
From the System Setup Screen enter the provider numbers:
Provider Numbers used by Healthcode are the Consultant’s GMC number with a 0 in front for all insurance companies (they are not using the Provider Numbers supplied by the companies apart from the BUPA one)
Insurance Companies need to be set up in the format shown below
Many existing entries in your data will work without the need to set up new company names
(If you modify existing entries you will need to reselect the Insurance Company for each patient for whom these companies have been entered in order to update the patient record)
If you wish to enter new names then please use entries from the table below Healthcode ID (can be used as Insurance
company name)
Other name formats that will work
BUP BUPA
BUI BUPA International
PPP PPP, AXA PPP
NUH Aviva
EFS Exeter Friendly Society, Exeter Family Friendly Society
CIG Cigna Healthcare
SLH Standard Life Healthcare
BCW Simply Health Remedi and HSA
PRU Pru Health Vitality
HHS Healix Healthcare Services
WPA Western Provident Association
New Consultation types need to be entered
In the Setup and Maintenance menu select consultations
You will need to add consultation types that have an industry standard code. The commonly used ones are:
E0000610 Initial Consultation E0000640 Follow up Consultation
The Appendix below lists other codes advised by Healthcode
Several instances of each consultation code may be used and descriptions changed. Descriptions must be unique and must not include characters such as £ @ &
You should also enter the appropriate fees
EDI for Departments
The default setting for systems with departments is that all EDI claim files will contain Department 1 details for the claim
PPM can be configured to show individual department details on an EDI Claim file.
If your system has been set up with departments, and you wish to have individual department details in the EDI Claim file you should go to System Setup (from Setup and Maintenance) and click the Edit Departments button. Enter the appropriate provider number in each field.
Then go to the user options screen and uncheck the box ‘consolidate edi departments’
If a provider number is present for an invoice raised for that Insurance Company for that department then that provider number will appear on the invoice. If a provider number is not present then the first department provider number will be used.
EDI Needs to be Enabled
Go to Setup and Maintenance, Click User Options The tick box ‘Disable EDI’ should not be ticked
The tick box ‘Default Patient to EDI may be ticked or not as you choose
Using EDI
On the Patient Screen set the Patient to EDI:
This is done by clicking the EDI claims button in the Patient options part of the screen The billing type must be set to Patient with Insurance Cover
An Insurance Company and Policy number must be present The EDI Consent box should also be ticked
The policy number search button to the right of the policy number box may be used to check BUPA policy numbers
It is important to note that the post code must be in a valid format
For overseas addresses Healthcode can provide a UK format post code for any Country
If a GP is present, the GP record must include at least a first line of address and a post code in a valid format
Raising Invoices
Enter the details of the consultation by entering the required information and then marking the invoice to be included in the next batch:
Note that the consultation type must contain a valid EDI code. A Diagnosis is required
Healthcode have advised that in the absence of a specific diagnosis the code 78000 ‘General Symptoms’ may be used
Healthcode have also advised that the OSICS version 10 diagnoses are recognised by their system A Pre-authorisation code is not required, but if entered will be validated, so must be correct Multiple consultations carried out on the same or different days may be submitted on a single invoice
Consultations and procedures may be entered on the same invoice where the treatment dates are the same
Enter the details of the Procedure by entering the required information and then marking the invoice to be included in the next batch:
You should enter all dates for Day case and Inpatient procedures
For Outpatient procedures you should enter just the procedure date, remove the discharge reason and change the ‘In Out Daycase Theatre’ box to O
An edi submission will fail if it is made before the discharge date entered on the screen A hospital is required and must have a valid hospital code
A service code must be entered.
Use either C0000010 Surgeons Fee for theatre or C0000020 Anaesthetists Fee for Theatre A Diagnosis is also required. This can be 78000 General Symptoms as above
When the invoices have been raised they can then be validated for EDI submission.
From the Patient screen select ‘Links’ then ‘EDI’ or from the Main menu select ‘EDI & Laboratory Work’
Click ‘Create a claim file’ to display the screen shown below showing how many claims are to be included in the validation:
If the user clicks on the option to create a claim file and the file already exists (but has not been submitted) the following message is displayed:
The following screen is displayed when the claim has no errors:
Errors can be corrected on screen to clear the messages in the Validation Errors box. Once the record is validated, click on the button to submit individual EDI invoice. This then uploads the details to Healthcode FTP site and the system validates the claim. If the claim passes the validation at Healthcode the following message is displayed.
If the claim fails validation at Healthcode the error message shown below will be displayed on the screen
The invoice should be removed from the claim using the ‘Remove the invoice from this claim’ button at the top of the validation screen
The submission should then be corrected and then resubmitted.
As there are a number of errors that could be reported please call the support desk on 0116 2715130 for assistance with this.
EDI Claim History
From the EDI menu select EDI Claim History to display a list of claims that have been submitted
On the claim history click ‘EDI Claim Status Request to get an update on the status of the claim:
Appendix
Codes that may be used on the Consultation screen as advised by Healthcode E0000610 Initial Consultation
E0000640 Follow up Consultation E0000700 Consultation - Second Opinion C0000140 Professional fees C0000140 Sinus washouts C0000140 Smell tests C0000180 Inpatient care L0006000 Audiology L0003130 Tympanometry L0003200 Visual Field Test
T0003000 Chemotherapy 1-7 days T0003100 Chemotherapy 1-14 days T0003200 Chemotherapy 1-21 days T0003300 Chemotherapy 1-28 days
If you have an activity, not in the above list, which you would like to invoice from the Consultation screen, please call the Support Desk on 0116 2715130 and we will work with Healthcode to find an appropriate code.
Please note that the PPM system contains many industry standard service codes that Healthcode do not use
