Allied Health Claims in Communicare

1. The allied health workers must have their provider number(s) recorded in the Provider Table in Communicare for each encounter place. This can be done by your Communicare Administrator or by the provider themselves, by going to File|Reference Tables|Provider. Check the 'Always show the Medicare items...' checkbox only if the allied health worker is going to make claims themself. Ticking this box will mean that each time the Health Worker closes the Clinical Record, the Medicare items list will be displayed for the Health Worker to tick the item to be claimed. If this box is not ticked, then the Health Worker must click on the yellow triangle at the bottom of the clinical record to display the Medicare Items or do the same thing in the Service Recording window. The Health Worker must also be registered with Medicare Online to make electronic Medicare claims.

2. The allied health workers must be entered in the Address Book. Check the 'Referrals Place' checkbox. (File|Reference Tables|Address Book)

3. The referring doctor must make a referral using the appropriate Allied Health template to the appropriate allied health worker. This authorises qualified allied health workers to make a specific number of claims for a specific item.

4. If the healthworker is part of a service with another provider who has a provider number recorded in Communicare, then the claiming provider must either:

a. have the claimant box (to the right of their name on the Detail tab), ticked to show they are the default claiming provider on this service, or;

b. In the Medicare tab make sure that the Provider selected is themself for each item being claimed by them.

IF THE ALLIED HEALTH WORKER IS MAKING CLAIMS then they should find the Medicare claims form by either clicking the yellow triangle at the bottom of the clinical record or by closing the clinical record (if they are in the clinical record for that service).

IF A DESIGNATED USER IS MAKING THE CLAIMS then they find the Medicare claims form by clicking yellow triangle in Service Recording or Bulk Bill Status.

5. Marking a service as 'Not claimable':

a. If there is only one potential claimant on a service and there is no claim to be made then the service should be marked as not claimable;

b. If there is more than one potential claimant on a service then the service should only be made not claimable of no-one is going to make a claim. This means that if a healthworker sees a patient and is not going to make a claim they should NOT mark the service non claimable if the patient is then going to see a doctor otherwise the doctor will not be prompted to make a claim. Similarly a doctor should not mark a service as not claimable if the healthworker has initiated a claim and this has not yet been sent to Medicare.

Useful report

The report at Report|Electronic Claims|CDM Summary for Selected Patient is useful for checking which EPC items have already been claimed for a patient.