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

Raise the invoice in the normal way

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:

Click ‘Create claim file’ to display the following screen:

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:

If there are any errors in the record then the screen will be shown as below:

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.

Please do not delete the invoice as it will assist us in identifying the problem

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:

Click ‘Yes’ to look at the string response from Healthcode system

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