Patient Identifiers - Medicare Cards & Online Patient Verification (OPV)

Online Patient Verification (OPV) checks a patient’s Medicare details against the Medicare database, ensuring accurate billing and claims within MediRecords. Verifying details up front reduces the risk of rejected claims, payment delays, and the need to chase patients for updated details, while strengthening patient confidence and reducing time spent fixing errors. OPV checks run automatically at key points in the workflow, such as adding patients, creating appointments, or processing invoices, and can also be run manually whenever you need to validate a patient’s record.

Contents

1. What is an Online Patient Verification (OPV)?
2. Adding Medicare Card Details
3. Running an OPV Manually
4. Automatic OPV Behaviour
5. Troubleshooting

What is an Online Patient Verification (OPV)?

Submitting an OPV request for each-and-every patient that has a Medicare card is very important. By verifying that your patient information matches the patient's identity within the Medicare database ensures that Medicare claims will be processed smoothly and without delay.

Adding Medicare Card Details

1. Open the Patient record.
2. Navigate to the Details tab.
3. Click Settings.
4. Navigate to the Medicare heading.
5. Update the form with all the required details.
6. Click Save to apply the changes.

Running an OPV Manually

You can submit an OPV request from within Patient Details, the Patients List, and when you are creating a new Invoice in Patient Accounts. You can also submit an OPV request from within a patient booking in the Appointments Calendar. Each of these methods will be covered individually in this tutorial.

If verification has not been run for Medicare or DVA patients within 7 days of processing an invoice, the claim will sit in the Unclaimed Amounts section of the Claiming tab until a check has been successfully run.

1. To submit an OPV request from within Patient Details, open a patient record, navigate to the Details tab and click Settings.
2. Check to make sure the Medicare Card No. is up-to-date, and then click OPV. NOTE: After an OPV request has been submitted, it takes Medicare approx. 10 to 15 seconds to respond. Please be patient while waiting for Medicare to respond, and do not close or refresh your browser during this process.
    
3. When an OPV request is successful, and the Medicare Card No. has been validated, click OK to close the notification and return to the patient record.

Other Manual OPV Locations:

• An OPV can also be run for multiple patients from the Patients List by selecting multiple patients, and clicking OPV.
  
   
• A manual OPV request from the Appointment Calendar can also be run by clicking the Timeslot assigned to the patient in the appointment calendar to open the booking form. Click More > OPV Check.
  
   
• A manual OPV request can be run from within an Invoice prior to billing by hovering over the 'i' beside the patient details within the Invoice and clicking OPV.
  

Automatic OPV Behaviour

• When booking an Appointment, an OPV will automatically be run for the patient.
• When a patient's Appointment is added to the Waiting Room, an OPV will automatically be run for the patient.

Troubleshooting

Failed Medicare OPV Check

Cause: The Medicare OPV check fails when the patient’s name, date of birth, or Medicare card details recorded in MediRecords do not match Medicare’s records.

Resolution:

1. Open the patient record
2. Make sure you are in the Details tab
3. Click Demographics
4. Make sure the First Name and Last Name is correct
5. Make sure the Date of Birth is correct
6. Ask the patient for their Medicare card
7. Open the Settings Tab
8. Make sure the First Name and Last Name on the Medicare Card match the patient's record
9. In some cases, the patient's maiden name may still be on Medicare Card
10. If the name is different, click the Use Alias tick-box next to the MEDICARE heading. Using an alias means that the "alias" name will be submitted to Medicare to claim the rebate
11. Type in the patient's First Name and Last name as they appear on the Medicare card
12. Make sure the Medicare Card No. is correct
13. Make sure the card IRN is correct
14. Make sure the card Expiry Date is correct
15. Once you have checked and updated all details, click Save to apply the changes. If you do not Save the changes, the OPV will fail again.
16. Click OPV to submit the request

Escalate: If the OPV check still fails, the patient will need to contact Medicare Customer Service and check their first name, last name, DOB and address are correct. The phone number for the Medicare Customer Service line is 132 011.

Further Reading

• Medicare & ECLIPSE: Claiming Errors & How to Fix Them
• Medicare Error: 8018 - Patient Details Submitted did not Match Veteran checks / Patient Details were not an Exact Match
• Patient Claims - Medicare, DVA & ECLIPSE: Quick Guide