Bulk Bill Claims (Online Claiming)

Use the Claims Status (Online Claiming) > Bulk Bill Claims tab to manage claims bulk billed to Medicare using Medicare Australia's online claiming.

Encounters list

The encounters list shows all encounters that have been generated since online claiming was enabled, and:
  • Have a provider with a valid provider number or have a claim item set
  • Are not marked as Not claimable (see Service Record Maintenance for details)
  • The patient is not fictitious
  • The encounter status is waiting, started, paused or finished (but not withdrawn)
  • Have not been paid
  • Are within the legal time limit for electronically claimable services imposed by Medicare Australia
The fields in the encounter list are:
  • Claim status, which is one of the following:
    • Claim in progress iconClaim in progress
    • Claim status unknown iconClaim status unknown
    • Claim pending icon Claim pending
    • Claim rejected icon Claim rejected
    • Claim paid icon Claim paid
  • Information - for example, Medicare details missing iconMedicare Card details incomplete, displayed for an encounter if the patient's Medicare Card details are incomplete
  • Encounter Date and Time - the start date and time of an encounter. If only the date is used, the date of the encounter.
  • Patient Name - the patient's given names. If the patient is registered for HCH and the tier is recorded, the patient's HCH tier detail is highlighted.
  • Patient Family Name - the patient's family name.
  • Status - the current status of the service claim. There can be multiple claims for one encounter which are itemised separately.
    Note: If Batch claim is enabled, all services batched together have the same claim ID, and have a status of Batch claim before claiming.
  • Claims Admin Note - click Admin Note iconAdmin Note to add or edit any notes associated with the claim.

Filtering the encounters list

Set filters to limit the number of claims displayed.

To filter the encounter list:
  1. Apply one of more of the following filters:
    • Claim ID - enter a value to list claims that contain only the specified claim ID. Enter as much of the claim ID as required. For example, P003 returns P0031@, P0031@... P0039@.

      To search for inpatient claim IDs, enter a search term starting with #. For example, #P003 returns #P0031@, #P0032@...#P0039@.

    • Claiming Provider - select a provider from the list to display claims only for that specific provider
    • Encounter Place - select an encounter place from the list to display claims only for a specific Encounter Place
    • Show Paid Claim - set to display only paid claims. By default, Communicare displays only those claims that have not been paid.
    • Use Time Limit - by default, only claims that are within the 2 year legal time limit imposed by Medicare Australia for electronically claimable services are displayed. Deselect to display all claims up to 50 years old.
    • Minor ID - select a minor location ID from the list to display claims only for that location ID.
  2. Click Apply Filters.

Only those encounters that meet the filter criteria are displayed.

To display all encounters again, click Reset Filters.

Viewing and editing encounters

From the Claims Status (Online Claiming) > Bulk Bill Claims tab, you can edit encounters that haven't yet been sent or view them if they have. Typically, you would edit encounters that fail validation.

Select the encounter you want to view or edit and select one of the following options:
  • Edit iconEncounter - click to open the service record so that you can claim a service associated with the encounters.
  • Patient details icon - click to edit patient details, including specifying or updating a Medicare number
  • Progress note icon - click to view the progress note associated with the immunisation
  • Print icon - click to print out a Medicare online claiming bulk bill assignment of benefit form for the selected patient
  • Admin notes icon - click to add an administrative note about the encounter

Claims list

Claims are automatically sent to Medicare by Communicare using Medicare Australia's online claiming after a service is claimed. See Submitting a Medicare Claim for more information about first submitting a claim.

Select an encounter from the encounters list to display information about the claims associated with that encounter in the claims list.

Information about a claim includes:
  • Claim ID - unique identifier for a given month, which together with the date, identifies a claim within the online claiming system
  • Sent - flag showing that the claim has been sent to Medicare Australia. If a claim is sent it cannot be modified.
  • Transmission Date - the transmission date if the claim has been sent
  • Claiming Provider - claiming provider for the claim
  • Claim Status - current state of the specific claim. A claim can have one of the following states:
    • Error: Claim not sent - please retry
    • Claim waiting in queue
    • Claim sent - Awaiting processing
    • Claim processed - Awaiting Payment
    • Claim paid by Medicare Australia
    • Claim rejected - View Medicare Australia Report
    • Claim discarded - when a rejected claim is retransmitted, the original claim is discarded
Tip: Click Get Reports to force Communicare to check the processing of a claim.

If a claim shows an error or is rejected, investigate the reason. If there is a problem with the patient or service record, correct it so that the claim can be resubmitted. For more information, see Using Bulk Bill Claims (Online Claiming).

Claims are sent at the interval and times configured in CCareQueue_HIC.exe. By default, CCareQueue_HIC.exe runs hourly, 9am-8pm.

Claim details

For a claim selected in the claims list, if there was an attempt to transmit the claim to Medicare Australia, details about the claim are displayed at the bottom of the window:
  • Result Text Message - details of an attempt to send a claim. This may detail reasons for a failure to send. You can look up a Medicare reason code at http://www.medicareaustralia.gov.au/provider/vendors/reason-codes/medicare.shtml.
  • Minor Location ID
  • Provider Number
  • Payee Provider No.
  • Transmission Date - the date and time when this claim was transmitted to Medicare Australia if it was successfully transmitted
  • Report available
  • View Medicare Australia Report - click to display the report received from Medicare after a claim is processed, which shows reasons for rejection, and so on
  • Payment Details - details of payments made for a processed claim