Medicare -Practice Claiming (Accounts)
In this article, you will learn how to manually submit Medicare batch claims.
To learn about billing the different ways of billing patients, please click here
*NOTE: Submitting batch claims is the same process for both Medicare Bulk Billing and DVA claims.
When automatic claiming is not switched on, you will need to manually submit your claims to Medicare via the Claiming (Accounts) module. This process is normally done in batches, either at close of business, or at set times throughout the day.
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 tutorial.
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.
To filter the list of unclaimed services, click Filter to reveal a drop-down list, and then select a filter under Channel or Provider. You can make multiple selections from the filter list.
To search for an unclaimed service, click the Search-box and type in a Keyword from the Patient name. Press Enter and the system will display a list of closest matches.
You can also search using keywords from any of the column headings - including Channel, Provider, Item and Invoice No.
To submit an individual claim, click the Tick-box next to the name, and then click Claim.
*NOTE: All unclaimed amounts on the same invoice will automatically be selected. You cannot break-up or submit partial claims from a single invoice.
To submit all pending claims in a batch, click the Tick-box in the top left-hand corner of the grid to select all unclaimed amounts.
Click Claim to submit the claims.
*NOTE: If there are "Red" unclaimed amounts in list, they cannot be submitted to Medicare. This is typically because the system has detected a problem relating to the patient's Medicare profile, or to do with OPV (Online Patient Verification).
To find out why an unclaimed is unable to submitted, hover your mouse over the "i" icon. When the cursor turns into a Finger Pointer, the reason the claim cannot be submitted will pop-out to the side of the icon.
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 you have submitted the claims, the Claim Submission Results will open. Take note of the Claim No. to track the progress of the claim.
You have the option here to Print a copy of the Results for record keeping purposes.
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.
All claims that have been submitted to Medicare, 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 to Medicare 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, this typically takes 24-48hrs.
To filter the list of claims, click Filter to reveal a drop-down list and select a filter under Channel or Provider. You can make multiple selections from the filter list.
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, Amount and Status.
Claims within the In Progress module will have a Status of either Submitted or Processed. Please refer to below for an explanation of the of these status'.
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.
Claims with a status of 'Submitted' will need to be manually processed so that they appear on the Medicare Processing Report.
To push the claims forward to the next stage of processing, click the Tick-boxes next to the claims, and click Process.
Claims with a status of 'Processed' and have a $0.00 balance in the Owning 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.
Once payment is confirmed, click the Tick-boxes next to the claims, and click Process.
This will move the claim from the In Progress module, to Claims Completed this Week
Claims with a status of Processed and have an amount owning in the Owning 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 displays a summary of the service or services associated with the claim. The Status displays which services have been Fully Paid, and which are Unpaid.
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 claim has been rejected and unpaid due to a duplicate service on the same day.
When a claim is rejected, it needs to be resubmitted to Medicare with additional information.
To resubmit a claim, click the Tick-box next to the name to reveal additional options. Click Open Invoice to open the original claim invoice for editing.
When the invoice form opens, hover your mouse over the left-hand side of the line of the invoice that been rejected. When the cursor turns into a Finger-Pointer, a Pen Icon will appear.
Click the Pen Icon to edit the individual line of the invoice.
In the case of Medicare rejecting the claim due to a duplicate service, when the Edit Item form opens, click the Not a Duplicate Service tick-box. Also add the exact Time of the Service, and some additional Comments.
Click Save to apply the changes and return to the invoice form.
Click Update to apply the changes to the invoice, and you will be returned to the Claim Details.
(An updated Medicare claim form may open in a new tab where it can be printed)
You will now need to resubmit the claim to Medicare, with the updated details about the service.
Click the Tick-box next to the name to reveal additional options. Click Re-Submit to move the invoice item back to the Unclaimed Amount module, where it can be resubmitted to Medicare, as part of a standard batch submission process.
Claims Completed this Week
Once as claim has been processed by Medicare it is automatically moved to Claims Completed this Week.
The completed claims summary gives you an overview of the most recently completed claim, the Medicare Channel that they were submitted to, and the amount claimed and paid.
*Note: The Paid column reflects how much was paid to the practice for that claim, not the patient. In the case of PCS - Medicare (Bill to Patient), the completed claim will reflect a zero dollar balance, because the patient received the rebate, not the practice.
To filter the list of completed claims, click Filter to reveal a drop-down list, select one or more filter options under Channel and/or Provider.
To search for claim, click the Search box, and type in Keyword from the provider's name.
Press Enter and the system will display a list of the closest matches.
To view the services associated with a claim, click the tickbox next to the claim and click View Service.
To view the lodgement advice associated with a claim, click the tickbox next to the claim. Click More to reveal a drop-down list, and click View Lodgement Advice.
To export completed claims, click the tickboxes next to the claims. Click More to reveal a drop-down list, and click Export.
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