Retrieving Claims from Data Exchange Gateway (DEG) and uploading them to Illuminate
After submitting a Claim Batch to the DEG (Data Exchange Gateway) you will need to revisit the site multiple times in order to retrieve the RA (Remittance Advice) files. There should be two RA files to retrieve. One is the RA Accepted from the Claim Batch submitted and the second will be the RA Rejected. They do not show up in DEG at the same time so you will need to go back into DEG until both have been retrieved. Best rule of thumb is to go into the DEG site on Wednesdays (beginning the week after you submitted a Claim Batch by Tuesday at 5:00p.m.) until you have retrieved bot RA files. The DEG site only keeps files/messages available for a short length of time so be sure to check often so you do not miss any.
1. Click on Browse and select the RA file that you downloaded from the DEG website.
2. Click on Submit.
You will repeat this process for the second RA file that you download from DEG once it becomes available to you in DEG website.
View Remittance Advice
1. The RA Summary will give you an overall Summary of the Batch and show what was Accepted and Rejected along with the total number of Claims.
2. The RA Accepted will show all of the claims that were accepted.
3. The RA Rejected will show all of the claims that were rejected.
1. If you have uploaded the RA Accepted Claims file to the Batch, the screen will show the total number of Accepted Claims and detailed information about each Claim.
2. If you have not uploaded the RA Accepted Claims file to the Batch, this screen will prompt you that the Claim has, "No accepted claim information". The RA Accepted file will need to be uploaded to the Batch. See "Adding RA (Remittance Advice) to Claim Batch" for detailed information on how to upload an RA file to a Claim Batch.
1. If you have uploaded the RA Rejected Claims file to the Batch, the screen will show the number of Rejected Claims and give detailed information about the Claims.
2. If you have not uploaded RA Rejected Claims into the Batch, the following error will show, "No rejected/denied claim information". The RA Rejected file will need to be uploaded to the Batch. See "Adding RA (Remittance Advice) to Claim Batch" for detailed information on how to upload an RA file to a Claim Batch.
1. After you have reviewed the Rejected Claims and corrected any areas that needed to be addressed such as: Missing Medicaid Consent or either out-of-date or missing Scripts/Referrals on file in Illuminate you will then Unlock NPI Claims for Resubmission. See "Unlocking NPI Claims for Resubmission" at http://help-ise.illuminateed.com/m/8469/l/185948-unlocking-npi-claims-for-resubmission.