In this article, you will be shown the claim submission process including what happens after you submit a claim, where processing reports are automatically retrieved by MediRecords and where action is required by the user to complete claims. In addition to this, we will briefly explain the claim payment report.
After submitting a claim there are several stages of claim processing:
- Submitting a claim
- Claim Assessment
- Process Report
- Remittance Advice
- Remittance Retrieved
- Partially Paid Claims
- Claims Completed
- Claim Payment Report
For DVA/Medicare channel
After submitting a claim through a DVA or Medicare channel, a claim ID will not generate untile Medicare has received the claim.
For ECLIPSE channel
A claim ID is generated for each individual invoice once received by Medicare.
Note: Submitted invoices will appear in the 'In Progress section of the claiming screen with the status of 'Submitted'. To open this page click Accounts at the top of your MediRecords screen to reveal a drop-down list, then click Claiming, followed by the In Progress doughnut. 
Medicare/DVA and Health Fund asses claims at the Item level and a process report are issued when a complete Claim has been assessed.
MediRecords retrieves available Process Reports nightly at 02:00AEST and marks associated claims as "Processed"
Any unpaid Claims have been assessed as ineligible and require user action.
To view the Process Report click the checkbox next to the claim, followed by More than View Process Report.
The Process Report will be displayed below. To view, more information regarding the invoices within the claim select the arrow next to the Service date.
For DVA/Medicare channel
A payment report will be issued by Medicare/DVA when they deposit funds; a grouping of payment reports is done by Provider number.
For ECLIPSE channel
Electronic Remittance Advice (ERA) is issued by Health Funds when they deposit funds within your account. The ERA lists individual claims.
To view the payment report select the Checkbox next to the claim followed by More then select View Payment Report.
MediRecords retrieves remittance advice nightly at 02:00AEST. Claims on remittance advice retrieved that night are given a fixed payment paid on a date. This includes partially paid claims.
Partially Paid Claims remain in the "In Progress" screen with the status of "Processed" until actioned by a User.
To action, a claim from the In-progress screen select the checkbox next to the claim followed by View Services. You will be shown a list of items with the claim that requires action. To action, an Item select the checkbox, followed by the action you wish to take.
For Example:
To accept a Partially Paid claim select the checkbox next to the claim Date followed by Accept Claim. This claim will now appear in the Claims Completed Donut and the Claim Payment Report.
Fully Paid Claims and accepted Partially Paid Claims will transition to the Claims Completed Screen
The Claim Payment Report shows all deposits made for claims during the selected period. It will display details of completed claims only. Partially Paid Claims must be actioned to appear on the Claim Payment Report.
To view the Claim Payment Report select More at the top of your screen, followed by Reporting then Financial.
Then select Claim Payment Report.
To run the Claim Payment Report select the Practice, Provider, Claim Type and Date From and To. See an example of a claim payment report, look below.
