Claiming Overview

The Claiming dashboard in MediRecords is used to manage the flow of claims being submitted to Medicare, DVA and Health Funds. The Claiming module is primarily used when automatic claiming is not switched on. The process of submitting claims manually is normally done in batches and is typically be performed either at the close of business or at set times throughout the day.
In this article, you will learn how to manually submit Medicare batch claims.

To open the claiming module, click Accounts at the top of the page, and then click Claiming.
There are three sections within the claiming module - Unclaimed Amount, In Progress and Claims Completed this Week. Each of these sections will be covered individually in this article.

Unclaimed Amount

All claims that have not yet been submitted to Medicare will be visible in the Unclaimed Amount dashboard. These unclaimed services can either be submitted individually or as part of a batch.

Filtering

You can filter the list of unclaimed services by clicking the Filter button, then ticking a channel(s), or typing in a provider's name. You can make multiple selections from the filter list, if you wish.

Searching

You can also search for an unclaimed service by using the Search box. Type in a keyword, then press Enter, and the system will display a list of the closest matches. You can also search by channel, provider name, item number, and invoice number. 

Submitting

To submit an individual invoice as a claim, click the Tick-box to the left of it, then click Claim.
*NOTE: Items belonging to the same invoice cannot be submitted as separate claims. It you attempt to tick one item; you will find that all other items also on that invoice will be automatically ticked at the same time.

To submit all unclaimed invoices in a batch, click the Tick-box in the top left-hand corner of the grid to select all, then click Claim.

*NOTE: Any services in red font indicate a problem needs to be rectified before it can be submitted. To check the problem, hover over the small "i" next to the patient's name, and the reason will be provided.

If it is due to the patient's Medicare card number, an OPV check can be performed by going to More > OPV. OPV's must be completed with a successful result every 7 days.

Once a claim, or a batch of claims, has been submitted, a Claim Submission Summary will open. Review the summary, and then click Claim to send the claim to Medicare.

Once all unclaimed amounts have been submitted, they will be moved to "In Progress". There will be a Zero balance displayed on the Unclaimed Amount dashboard.

In Progress

All claims that have been submitted to Medicare, DVA or a health fund, and are either being processed, paid, or partially paid, will be visible in the In Progress claiming module.

*NOTE: If you are using automatic claiming, and are not submitting claims manually, then claims that have been fully paid will automatically be moved from "In Progress" to "Claims Completed this Week", once the payment report has been received.

Filtering

To filter the list of claims, click Filter to reveal a drop-down list and select a filter under Channel, Status, Payment Status or Provider. You can make multiple selections from the filter list.

Searching

To search for a claim, click the Search-box, and type in a Keyword from the Provider name. Press Enter and the system will display a list of the closest matches. You can also search using keywords from any of the column headings, including Channel, Payor, Amount, and Status.

Status

Claims within the In Progress module will have a Status of Submitted, Processed, Pending or Rejected. Please refer to below for an explanation of the of these statuses.

• Submitted - this means that claim has been successfully submitted to Medicare and is awaiting response from Medicare in the Processing Report.
  
• Processed - this means that the claim has been processed by Medicare, and the Processing Report is available.
  
• Rejected - this means Medicare/DVA/Health fund rejected the claim due to a problem. Hover over the small (i) to find out what the issue was. Once you have rectified the issue, you can resubmit it by ticking the claim and going to More > Re-Submit Claim.
  
• Pending - If the claim does not have a Claim Number, this means Medicare did not receive the claim, and you may wish to try re-submitting the claim. However in the case of continual non-receipt of claims, it's recommended you enquire with Medicare to ensure your provider's bank details are correctly registered for online claiming.

If you do not have the "Automatically Retrieves Medicare Rpt" (report) setting ticked in Configuration Settings, you will need to manually retrieve the process and payment reports. To do so, tick the Tick-boxes next to the claims, and click Process.
*NOTE: Some pointers when checking your Processed claims

Claims with a status of 'Processed' and have a $0.00 balance in the Owing column have been fully accepted by Medicare. However, before marking them as complete, you need to make sure payment has been received on the Medicare Payments Report.

Claims with a status of 'Processed' and have an amount owing in the 'Owing' column have acknowledged the claim, but have only agreed to pay a partial amount, or have rejected the claim.

Claims that have been fully rejected or only partially paid by Medicare, need to be investigated, and the actioned appropriately once the reason for rejection has been established.

To open the details of a claim, to view the associated services, click the Tick-box next to the claim, and click View Services to open the details of the claim.
The claim details display a summary of the service or services associated with the claim. The Status displays which services have been Fully Paid, and which are Unpaid.
In the case of a claim being unpaid, there will be a brief description as to why Medicare rejected it.

Rejections

Claims can be rejected or unpaid by Medicare for a number of reasons. The most common reason is "Benefit has been previously paid for this service", which means that Medicare detected that a claim has already been paid for the same or similar service in the last 24 hours.  

In the example above, the service has been rejected and unpaid as the user attempted to bill an out of hospital service to the health fund via ECLIPSE.

To resubmit a service, click the Tick-box next to the date, then click Re-Submit.

You will be asked if you would like to create a new invoice for resubmission. You must always click Yes.

In the case of Medicare rejecting the claim due to a duplicate service, you can edit the item and click the Not Duplicate Service tick-box, then click Save. Also adding the exact Time of the Service and comments in the Service Text field can help. Click Claim to submit the new invoice.

Claims Completed

Once a claim has reached the end of its life cycle, it will move to the Claims Completed section. This can include fully paid claims, and partially or unpaid claims that were accepted or re-submitted.

The Claims Completed section will by default show claims completed this week to date, but this can be changed to other date ranges if desired, by clicking the downwards arrow.

All patient claims will also move directly to this section. This is because when a patient has paid for their account, the Medicare rebate is then issued directly to the patient, and no financial transaction is left remaining between the provider and the patient.

If you have sent a patient claim in error, it is possible to delete it before 5pm the same business day. For instructions on deleting a Medicare patient claim, please see this article.

You may now wish to see a more detailed article about the process of Managing Claim Rejections.