Patient Claim Management

Patient Claims are Medicare Claims lodged by patients who have received professional medical services, but have not assigned their rights to Medicare benefits to the Servicing Practitioner.

Communicare supports Interactive Patient Claims which allows real-time processing of a single claim and is available during Medicare operating hours.

Real-time processing follows a cycle of:

Transmit
Assessment
Return of an outcome to the sending location

To submit a Patient Claim on behalf of the patient, follow these steps:

At the end of the service, on the Private tab:
1. In the list of Medicare items, select all items that apply.
2. From the Payment Method list, select the payment method used.
3. In the Amount Paid field, enter the amount paid. Click Pay In Full if the patient paid the full account.
4. Generate the invoice for the service, click Invoice / Receipt.
In the Invoice window, select Patient Claim > Claim now.
Note: If the button is not available, the claim has already been submitted. Patient Claim > Claim now is also disabled if:
- There is no MBS item to claim
- The provider doesn't have a provider number
- The Communicare client is offline.
On the Patient Claim Summary window, review the claim details:
- To submit the claimant's address to Medicare, set Include Claimants's Address.
  Note: The claimant's address must only be transmitted at the request of the claimant. For Medicare, these address details are temporary and must be used for that claim only. If no address is supplied, the address held by Medicare will be used for correspondence relating to the claim.
- The following business rules apply:
  - Where a patient has only one name, that name should appear in the Patient Family Name' field and the word Onlyname be entered in the Patient First Name field.
  - A claim can include up to maximum of 14 items, any further items are discarded from the claim.
To submit the claim to the Medicare, click Submit Claim.

If the claim is successful, a Statement of Claim and Benefit Payment is generated and displayed. Print this statement and give it to the patient. For successful claims, Patient Claim is replaced with View Claim.

If the claim is unsuccessful:

With a non-fatal error - the claim is referred to a Medicare operator for assessment and a Lodgement Advice statement is generated and displayed. Print this statement and give it to the patient. The patient must contact Medicare for further claim updates. Patient Claim is replaced with View Claim.
With a fatal error - the claim has been rejected by the Medicare. An error code with a message is displayed and no statement is generated. The claim can be resubmitted once the error is fixed.

Deleting a Patient Claim

A request to delete a patient claim can be submitted to Medicare only if it is submitted on the same day as the claim has been successfully accepted by Medicare.

To submit the delete request:

Click Delete Claim.

Tip: If the date of submitting the claim is different from the date on which the claim needs to be deleted then the Delete Claim button is not visible.

If required, you can resubmit a patient claim. A patient claim can be resubmitted only if:

Patient Claim has been rejected by Medicare
Patient Claim has been deleted (Same Day Delete)

To resubmit a Patient Claim, on the Invoice window click Patient Claim. If the claim cannot be resubmitted, the button is not visible.

Batch Claim

If the Batch claim organisation parameter is enabled, and a patient or their payer has paid separately for more than one service from a provider, you can batch claim from Medicare.

To submit a batch claim on behalf of the patient, follow these steps:

At the end of the final service for that patient for the day, on the Private tab:
1. In the list of Medicare items, select all items that apply.
2. From the Payment Method list, select the payment method used.
3. In the Amount Paid field, enter the amount paid. Click Pay In Full if the patient paid the full account.
4. Generate the invoice for the service, click Invoice / Receipt.
In the Invoice window, select Patient Claim > Batch Claim . The batch details from the selected invoice together with other invoices for the selected patient or payer and provider for services today are displayed.
Note: If the button is not available, the claim has already been submitted. Patient Claim > Claim now is also disabled if:
- There is no MBS item to claim
- The provider doesn't have a provider number
- The Communicare client is offline.
On the Patient Claim Summary window, review the claim details:
- Invoices are batched under a single claim. Deselect an invoice to remove it from the batch claim. Only one batch can exist per patient, per provider, per payer. The next batch can't be created unless the existing batch is claimed. One claim can have only one set of referral data, so the user needs to submit the claim separately if it has multiple referral-related data.
- To submit the claimant's address to Medicare, set Include Claimants's Address.
  Note: The claimant's address must only be transmitted at the request of the claimant. For Medicare, these address details are temporary and must be used for that claim only. If no address is supplied, the address held by Medicare will be used for correspondence relating to the claim.
- The following business rules apply:
  - Where a patient has only one name, that name should appear in the Patient Family Name field and the word Onlyname be entered in the Patient First Name field.
  - A claim can include up to maximum of 16 items, any further items are discarded from the claim.
To submit the batch claim to the Medicare, click Submit Claim.

If the claim is rejected, the claim for all services (invoices) of the batch is also rejected. To resubmit, batch the services again or claim them individually.

In case of same day delete, if the claim is deleted, the claim for all the services (invoices) is deleted. Create a new claim and resubmit it if required.