Patient Claims - Medicare, DVA & ECLIPSE: Quick Guide

Processing patient claims in MediRecords is simple using the Bill to Patient workflow. This method is used when the patient pays the full invoice upfront and then claims their rebate directly from Medicare. Depending on whether the patient has registered their bank details with Medicare, the rebate will either be paid directly into their bank account or issued as a cheque to their registered mailing address.

This article explains the different types of patient claims and guides you through creating, processing, and deleting a claim. Understanding these workflows helps ensure accurate billing records and smooth reimbursement for patients.

📌 Important: Your billing configuration determines whether invoices, payments, adjustments, and refunds can be created or edited in any practice, or only in the one you’re logged into. With Centralised Billing enabled, you can bill across practices (be sure to select the correct one), while disabling Centralised Billing locks billing to the current practice to reduce errors. For more information on Centralised Billing, please see this article.

 

Contents

1. Types of Patient Claims
2. Creating a Patient Claim – Fully Paid by Patient
3. Creating a Patient Claim – Patient Pays Gap Only
4. Creating a Patient Claim – Bill to Head of Family
5. Creating a Patient Claim – Alternate Claimant
6. Deleting a Patient Claim
7. Assignment of Benefit (AOB)
8. Related Reading

Types of Patient Claims

• Fully Paid

  The patient pays the entire invoice amount at the time of billing. Once the claim is submitted, the Medicare rebate is paid directly to the patient’s registered bank account (or by cheque if no bank details are registered).
   

• Gap Only

  The patient pays only the gap between the invoice total and the Medicare rebate amount. Once the claim is submitted, the rebate is paid directly to the practice.

Creating a Patient Claim – Fully Paid by Patient

1. Open the patient record, navigate to Accounts > Invoices, click the New Invoice button, and select New Invoice to open the invoice form.
    
2. Complete all required invoice details, ensure the Bill To field is set to Patient, and tick Print Medicare Claim if you want to print a copy of the invoice showing the patient's rebate details.3
    

The Total reflects the full amount billed, while the GAP shows the patient’s out‑of‑pocket amount after Medicare reimbursement.

3. Click Quick Pay to display payment options.
4. Ensure Online Patient Claiming is ticked.
5. Select Full Amount, choose the Payment Method, then click Pay and Claim.

 

 

Creating a Patient Claim – Patient Pays Gap Only

1. Open the patient record, navigate to Accounts > Invoices, click the New Invoice button, and select New Invoice to open the invoice form.
    
2. Complete the invoice by setting the Bill To to Patient or Head of Family, selecting a fee Schedule or manually increasing the amount above the MBS item rate to automatically calculate the gap, then click Quick Pay.
    
3. Ensure Online Patient Claiming is ticked, then select the GAP Amount and Payment Method, and click Pay and Claim.

Creating a Patient Claim – Bill to Head of Family

If a patient is linked to a Head of Family and their account type is set accordingly, invoices will default to billing the Head of Family.

1. Open the patient record, navigate to Accounts > Invoices, click the New Invoice button, and select New Invoice to open the invoice form.
    
2. Complete the invoice, ensuring Bill To is set to Head of Family, tick Print Medicare Claim if required, and then click Quick Pay.
    
3. Ensure Online Patient Claiming is selected, then apply full or partial payment and click Pay and Claim.

 

 

Creating a Patient Claim – Alternate Claimant

In this scenario, the patient pays the invoice, but the Medicare rebate is refunded to an alternate claimant.

1. Open the patient record, navigate to Accounts > Invoices, click the New Invoice button, and select New Invoice to open the invoice form.
    
2. Complete the invoice with Bill To set to Patient, tick Print Medicare Claim if copies are needed for both patient and claimant, and click More Pay to open the payment form.
    
3. Select the Claimant and search for the alternate claimant registered in MediRecords, choose the Payment Type, enter the Amount, tick the invoice, click Automatically Allocate Payment, and then click Pay and Claim to submit the claim.

The processed invoice will appear in the patient’s Invoices list.

Deleting a Patient Claim

Patient claims can be cancelled if submitted in error, subject to time limits:

• Claims submitted before 5:00 PM AEST can be deleted up until 5:00 PM the same day.
• Claims submitted after 5:00 PM AEST can be deleted up until 5:00 PM the following business day.

To delete a claim:

1. Go to Accounts > Claiming.
2. Select Claims Completed.
3. Locate the claim and tick the checkbox.
4. Click More > Same Day Delete.
    
5. Select the appropriate reason and click OK.

The claim will be cancelled with Medicare. The invoice remains in the patient’s account and can be edited if required.