Claiming Glossary

Claiming Glossary

This glossary describes the key concepts and terminology used throughout the claiming process with MediRecords and is a good reference when setting up and using MediRecords' claiming function.

B - C - D - E - I - M - P - R - S - U -V 

B

Banking Report - Report total payment collections by payment type for a specific day. View cheque details for processing bank deposits. By selecting cash payments only, it can be used for the daily banking run. Assists with reconciliation.

Batch - Invoices can be sent in batches as part of a claim, meaning we can send a number of invoices in a singular claim see Claim (Medicare & DVA).

Bulk Billing - This involves the practice only charging patients the amount covered under the Medicare Benefits Scheme (MBS), with no additional fees on top

C

Claim (ECLIPSE) - Electronic Claim Lodgement and Information Service Environment.  An extension of Medicare Online Claiming, offering a secure connection between medical practices, public and private hospitals.

An invoice was submitted via the ECLIPSE channel for online assessment. Every invoice is assigned a unique Claim ID.

Claim (Medicare & DVA) - One or more invoices are submitted to Medicare for online assessment. Multiple invoices are grouped by Provider Number, sorted into Vouchers and Services, and assigned a unique Claim ID.

If a Claim ID populates in the Claim column, this indicates that Medicare has successfully received the claim.

Claim Channel (Medicare / DVA / ECLIPSE) - Depending on the claim type, claims are submitted through different channels to the Department of Human Services. The digital claiming channels available include Medicare Online, Medicare Easy claim, ECLIPSE, Medicare Bulk Bill Webclaim and Medicare Patient Claim Webclaim, Department of Veteran’s Affairs (DVA) Medical Webclaim and Department of Veteran’s Affairs (DVA) Allied Health Webclaim.

Claim ID - Unique Identifier given to each Claim when submitted and accepted by Medicare (e.g. @A0023).

Claim Payment Report - Displays all Claims that have a Payment Paid on Date for the selected report filter period. Can also be filtered by provider and claim type. Assists with reconciliation.

Claim Submission - Prompts system to assign the unique Claim ID and submit Claim through its respective Claim Channels.

Claim Submission Summary - Summary of Claim to be submitted to Medicare or Health Fund. For Claim (Medicare & DVA) it also shows the Vouchers and Services that will be created.

Claims Completed - This part is found in the Claiming Screen next to 'In Progress'. This section of Claiming contains all the Claims that have been transitioned from 'Unclaimed amount' to 'In progress' and lastly 'Claims Completed'.

D

Deposit - Any individual payment made into a nominated bank account by the Department of Human Services, Department of Veteran Affairs or a Private Health Fund. Every deposit has an associated Payment Report (Medicare & DVA) or ERA (Health Fund). 

Deposit Amount - The total payment amount as shown on the Remittance Advice. Health funds sometimes choose to make multiple Deposits for a single Electronic Remittance Advice (ERA).

E

ECLIPSE - Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE). Often referred to as Private Health Fund Billing - see Claim Channel.

Electronic Remittance Advice (ERA) - Remittance Advice from a Private Health Fund. Includes list of Claims being paid and Deposit amount.

I

IMC - In-patient medical claim (IMC) - see Claim (ECLIPSE Channel).

Income Summary Report - Summary of all payments received (including claims), refunds issued, and total amount for one or more Practices. Assists with reconciliation.

Invoice - An invoice documents all Items and the amount charged for them after applying any applicable billing rules

Item - Item is the unique code that identifies particular services listed in the selected Schedule. 

M

MR Scheduler - An automated process by MediRecords that runs nightly at 2am to retrieve Process Reports, Payment Reports, ERAs and match them with Claims in the system. Can be turned off by the User.

P

PAY Number (as of March 2019) - Unique MediRecords payment identifier when payment is manually entered or Remittance Advice is retrieved for online claims

Partially Paid Claim - A Claim for which only a partial payment was deposited by Medicare / DVA or a Health Fund. Requires user action to progress and appear on the Claim Payment Report.

Payment Paid on Date - The date on which a Remittance Advice has been retrieved in MediRecords a) by the scheduler or b) manually. It's recorded against all Claims included on the Remittance Advice and used for reporting on the Claim Payment Report. Once recorded, this date is fixed.

Payment Report - Remittance advice from Department of Human Services, Department of Veteran affairs. Issued by provider number and Deposit and lists the amount deposited.

Process Report - Outcome of claim assessment at item level. Only provided when all items on a Claim have been assessed by Medicare / DVA or a Health Fund.

Payee Provider - Nominated provider to receive Medicare claim payments. Can be the same as the servicing provider.

PRODA - Online identity verification and authentication system. It lets you securely access government online services.

Provider Number - Unique number issued to health professionals for every unique location they provide services from.

Patient Claiming (PCI) - Patient claims (PCI) are when the patient or a claimant (e.g., a parent) pays you for the full amount of the service, and you lodge a Medicare claim on their behalf

R

Rejected Claim - Claims that have been outright rejected prior to being assessed by Medicare / DVA or the Health Fund. Requires user to review rejection message and action

Remittance Advice - can refer to Electronic Remittance Advice (ERA) and Payment Report

Report Retrieval Date - See Payment Paid on Date

S

Schedule - Catalogue of Items and the value they will be charged at. Typically refers to the Medicare Benefits Schedule (MBS) but can also be custom created by an user.

Services - Only applies to Claim (Medicare / DVA) - see Item

U

Unpaid Claim - A Claim that has been assessed by Medicare / DVA or a Health Fund and will not receive any payment. Requires user action to re-submit or progress to completed.

V

Voucher - Only applies to Claim (Medicare / DVA) - The number of Invoices within a Claim.