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manual:billing_claims

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Claims

Select ledger you wish to view the claims history for, or select Show All Ledgers to view data for all clinics from your organisation.

Claims display in a table with the following columns:

  • Date
  • Claim ID
  • Name
  • Type
  • Provider
  • Service type
  • Number of visits
  • Status
  • Amount Claimed
  • Amount Paid
  • Errors

The table can be filtered by column, clicking on the column title to filter by A-Z and again for Z-A. The table can be further filtered by:

  • Keyword search
  • Claim type
  • Status

and by clicking Advanced:

  • Account
  • Provider
  • Show Claiming Errors
    • Both
    • Yes
    • No
  • Date Range

Add Visits to a Claim

You can add visits to a claim from the Visits screen, or from the claims screen. A visit must be free of errors and have any relevant validation steps such as Confirm DB4 completed in order for it to be able to be added to a claim.

From an Individual Visit

After confirming the DB4 (bulk billing) or D1216S (DVA billing) click on Add to Claim.

The visit will be added to an existing claim for that provider.

From Visits Tab

Click on Add visits to claims. All visits in the list that are in Draft status and have the DB4 confirmed (if required), will be added to the claim being created. you will be asked to confirm that you wish to move all items into the claim.


If you want to claim by date, by provider, or by any other custom grouping, filter the visits list first, then click Add visits to claims.

From Claims Tab

Click on Add Claims

You will be shown a list of all visits currently not included in a claim, listed by provider (alphabetical by Prefix (Dr etc) and first name). You can filter this list by typing a provider's name into the search field, otherwise the list will display as per the filters that were selected on the claims screen.

Only visits, without errors and with required validation steps (eg DB4 Confirmed) completed will display and be pre-ticked for selection.

To give the claim a custom name, record the details in the Claim Name field at the bottom of the screen. Click on Add Claims to add the selected visits to the claim you are creating.

You will see confirmation text and the claim will now be at New status. Opening the claim you will see the visits listed. You can review the visit details or remove a visit from the claim by clicking the relevant button. When satisfied the claim is ready, click on Send Claim to Medicare. you will be asked to confirm the action and the electronic claiming of these visits.

Naming/Renaming a Claim

Naming

On the claims tab, click Add Claim filter the list of visits by a provider. You will see a field titled Claim Name. Type the custom name here. If left blank, the default name will be used.

Renaming

Open a draft claim, or from a visit newly added to a claim, click on Claim Details.

The claim information screen will open.

Clear the Name field of the system generated name and record the name you would prefer to assign to the claim.

Claim IDs

Claim IDs are assigned automatically when the claim is submitted to Medicare. For your organisation they start at 0000 and increase by one for each claim submitted.

The claim ID is used to identify claims regardless of any name changes.

Claim Status

The status of claims is displayed in the status column of the Claims tab. At the top of the screen, the status of the individual claim that you are looking at will display in a “breadcrumb” trail which provides a visual indication of the claim's progress and status with regard to receiving payment from Medicare.

New

Pending

Submitted
Submitted claims have been sent to Medicare and are waiting for Medicare to process the claim OR they were processed and nothing was paid. NB: A payment report is required to move the claim to Complete status - if nothing is paid, a payment report will not be received. If a payment has been received and the claim is still not displaying one, contact Medicare to follow this up.
Complete
NB: a processing report AND a payment report must be received from medicare in order to have a claim move from submitted to complete. For a claim that has errors and is in submitted status, if a payment report has not been received in 7 days, a button titled “Accept errors and mark as complete” will appear.
Reconciled

Failed

Deleting a Claim

At the bottom of each claim is a Delete Claim button, click the button and confirm that you wish to remove all visits from the claim and delete the claim itself. The visits will be returned to “new” status.

Reclaiming

MMEx Billing now prompts you to address a range of common claim errors prior to adding a visit to a claim. Reclaiming related to provider numbers, medicare numbers and referrals should be greatly reduced. However, errors will still be received.

When an error has occurred with a claim and it needs to be reclaimed, open the claim to review the information and reports. After correcting any errors click on Reclaim all visits for this claim to resubmit the claim.

When a visit has been reclaimed, on the Visits tab you will see (Reclaimed) displayed adjacent to the visit status.

On the Claims tab you will see in the Errors column.
Opening the Visit, you will see displayed at the top of the visit, and the Visit History at the bottom of the screen which displays previous attempts at claiming the visit and which items were claimed each time.
You can use this information to identify which the items that have been attempted in previous claim attempts. Click on Claim Details

A visit that is created with new items, in order to reclaim a previous visit will be indicated by\\
Clicking on Original Visit Details will show you the original visit for all reclaim attempts.

You can view the new visit's details by clicking on Reclaimed Visit Details This will open up a reclaimed visit screen. Modify the details that need to be addressed and add the visit to a claim by clicking Add to Claim

Claim Errors

Medicare provides return error codes to provide an indication of why a claim failed.

Common errors include:

Error Note Explanation How to prevent in the future
Bulk Bill additional item (BBAI) claimed incorrectly The wrong bulk billing item number has been attached to the visits. The patient was not eligible to claim the BBAI or the item that the BBAI was associated with has been rejected.Ensure the correct MBS items are attached. Check the patient is eligible, ensure the main item can be claimed
Service Possibly Aftercare Occurs where two services billed on same day at different times. This item can be reclaimed Note in the visit Medicare details pop up that the service is NOT AFTERCARE
Associated service not claimed - No benefit payableBulk Bull Additional Item has been claimed without an associated main item.Ensure each BBAI has an item linked
Maximum number of services for this item already paid Limit has been reached for the number of times the item can be claimed. This claim cannot be reclaimedCheck where there are limited numbers of services before sending claim through
Item number does not attract a benefit at date of service Item has been claimed too early. This claim cannot be reclaimed Check that the patient is eligible to claim the item (eg health check)
Benefit has been previously paid for this service This means the service has already been claimed and paid. This claim cannot be reclaimed Check that there is not a duplicate claim in the system
Details of Requesting Provider not Shown on Account/Receipt, No Benefit Payable for Service Performed by This Provider The required Referral has not been linked to the claim. This item can be Reclaimed by linking the required referral Ensure all speciality providers have relevant referral completed and linked to the claim

Claim sitting in submitted status

Common reasons for for this include:

  • Banking details online claiming form has not been received/processed by Medicare
  • Provider number and Location ID do not match - it is likely the provider is not completely/correctly set up for Medicare Online.
    • To avoid this situation, new provider visits should be left in Draft status until Medicare Online is confirmed as set up.

A processing report AND a payment report must be received from medicare in order to have a claim move from submitted to complete.

For a claim that has errors and is in submitted status, if a payment report has not been received in 7 days, a button titled Accept claim and mark as complete will appear.

Confirm that you accept the errors and understand that any outstanding debt will be voided. The claim will move to Complete status. Click Mark claim as finalised to finalise this claim and reconcile any associated payments. You will be provided with the option of recording the reason why the claim was voided.

The recorded reason will display in the reconciled claim.

Patient Claims

Patient online claiming sends the medicare claim to Medicare on the patient's behalf. There are two ways that you can create these in MMEx.

Option 1 - from Visits tab

On the Visits tab, select Add New Visit.
Select the patient you wish to bill and select billing type: Patient Claim.

Select an MBS billing item by entering an item number in the billing item search field or using the Advanced Search.

Click Save to create the visit record.


The following will display:

Record the patient's payment by clicking on Invoice Details.
You will need to finalise the invoice payment first before you can submit the claim to Medicare.
Scroll down to the payment section and record the payment details.
Click Make Payment

If received as cash, click Mark as Reconciled now, if not, reconcile the payment when it received into your organisation's bank account.
After recording the payment, click on Print Statement to provide the patient with a copy of the invoice/payment record and then click Claim Details.

Click on Send Claim to Medicare
To provide a copy of the lodgement advice, click on Print Lodgement Advice
When the claim has been sent to Medicare, the status will change from Submitted to Complete.

The claim will display in the claims list as Patient Claim, with no Payee details displaying.

Option 2 - from Invoices Tab

On the Invoices Tab, click Add new invoice.

Select the account for the patient you will be claiming the visit for (this may be an individual account or a family account) and set the billing type to patient claim.

Scroll down to Visits and click on Add new Visit.

In the Edit Visit window that opens, select the provider name, and add the required billing items.
To add a billing item, click in the item search field, type the item number, or select the number from the frequently used items list that appears.

In the Edit billing item popup, modify the total amount to reflect the full fee being charged if required. (This will represent the gap fee.)

When all visit items have been added, click OK to save the visit.
You will see that the visit has been added to the invoice.

Click Save Invoice

Click Create Patient Claim and confirm the action.

You will see the following message.

Click on Invoice details, scroll to the payment section and record the patient's payment amount and click Make Payment. The patient should pay the total amount prior to the patient claim being submitted.

The payment will display as ready for payment status until the money received has been reconciled in your accounts. It is preferable that the payment is reconciled in MMEx prior to sending the claim to Medicare so that the patient payment amount displays in the claim.

To print a receipt for the patient, click print statement.

Then click claim details and on the patient claim screen Send claim to Medicare.

You may print lodgement advice to provide a copy to the patient.


Finalising a patient claim.

Once the claim has been sent to Medicare it is considered complete.

You will not receive a payment report from Medicare as the payment is made to the patient.

Open the patient claim once it is in Complete status and payment from the patient has been received into your bank accounts, click Mark claim as finalised.

Confirm that you are also reconciling the payment.

Patient Claim status

Invoice and Payment step: Return to claims process: When sent to Medicare: To finalise this item in MMEx, finalise the claim.

Patient Claim Payment Reports


MMEx will receive no advice, communication or payment report from Medicare about this claim.
All future communication and payment is made with and to the patient.
Completed Patient Claims should be reconciled.

manual/billing_claims.txt · Last modified: 2019/06/27 02:58 by sarahb