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Knowledgebase : MoU Prepayments

The rejection file will be generated just after the pre-submission file, once a week. The file will be located in your MoU share folder under the Reports sub-folder. The file name will contains "DontMeetCriteriaReport.csv" The rejection file will cont...
In order to do that, you need to be on version V3R8D25 or later of Claimsure. In order to find all the pre-submitted claims for the week, you can easily run a search for all the claims that got pre-submitted during the week. For example, if you want t...
Since Claimsure V3R8D26, you can find the claims that don't meet the criteria using the Claimsure Advanced Search. After the pre-submission night, so on Tuesday Morning for VHI claims, the only un-submitted claims that are not pre-submitted will be the ...
CLAIMS ELIGIBLE FOR PRE-PAYMENT Hospital with billing interface: Once a pre payment file is placed in the shared folder file is processed and claims that are not fully submitted will have the submission due date populated on Claimsure. Pre Payment amo...
A claim is considered at risk if: * the claim was pre-submitted * the claim is still un-submitted * the submission due date is getting close In order to find those claims, you can on the Advanced Search: * Check the box "Pre-Submitted" * On...
A share folder has been set up by your IT in order to allow you to drop the pre-payment file to the share folder. In order to get correctly uploaded to the share folder, please follow the steps below: * Download the zip from VHI website. The zip fil...
CLAIMSURE V3R8D24 Claimsure V3R8D24 is not managing payments that are coming on unsubmitted claims. Therefore the payment will be processed on the background and will be added to the claim once this one will be submitted. So for example on Claim 123 th...
On Claimsure V3R8D24, because the MoU pre-payments are only on the background when the claim is un-submitted, a report is generated to let the users know about these payments. This report is called "WeeklyReport" but will be generated every 1st day of t...
To get selected for pre-submission a claim: * Must have a discharge date * Must have a hospital invoice attached to the claim * Must have a hospital invoice number * Must have a value for the hospital invoice value * Must have a numeric insura...
The VHI is responsible to put the files available for the users to download. For any questions related to when the files will be available, please contact MoUSupport@vhi.ie