Working with submitted Medicare Claims

Use File > Online Claiming > Bulk Bill Claims tab to manage the life cycle of a Medicare claim from the moment the claim is sent to Medicare until the moment of payment.

Once a bulk bill claim is submitted to Medicare and accepted by Medicare it is assessed for its validity. The assessment process determines how much of the claimed amount will be paid. The assessment can result in either the claim being rejected, fully paid or partially paid.

Reporting on Medicare

Whilst individual claims can be reviewed from the Online Claiming window, if you are reviewing bulk claims, refer to Communicare reports. Use the reports in Report > Electronic Claims to report on Medicare revenue and to reconcile practice accounts with Medicare Bulk Bill claims submitted with Communicare.

  • To reconcile bank account statements for paid claims, use Report > Electronic Claims > EFT Payments. This report:
    • Displays a list of payments made by Medicare Australia by date range
    • Can be filtered by payee provider number, and Minor Location ID
    • Shows date, run number, payee provider number and amount paid
    Note: The EFT Payments report reports only paid claims, so may vary from between other reports.
  • To check for claims that have been rejected, use Report > Electronic Claims > Rejected by Period. This report displays a list of claims that have been rejected by Medicare, for a selected date range. Partially rejected claims are also reported.
  • To check for claims that have been only partially paid, use Report > Electronic Claims > Partially paid with error message. This report displays a list of claims that have been partially paid by Medicare, for a selected date range. You can also include claims that have been rejected fully or show discarded claims only.
  • To investigate decreases in Medicare revenue, use Report > Electronic Claims > Check Items and Claims. Use this report to:
    • Cross check completed procedures or immunisations performed with Medicare Claims. The output includes only those services with the selected procedures or immunisations. Claims by any providers on the service are included.
    • Specify all items or a specific procedure or immunisation that normally attracts a Medicare claim to check that the correct item has been marked for claiming. All claims for each service are shown, regardless of whether they have been sent successfully or not.
    • Investigate claims that are associated with a single service.

Checking that all claims have been properly submitted to Medicare Australia

To find all claims that have not been transmitted:
  1. On the File > Online Claiming > Bulk Bill Claims tab, in the encounters list, click the Status column heading twice to order the encounters by descending claim status. All encounters with a claim that failed to be transmitted are listed at the top of the list.
  2. For an encounter, select a claim and look at the information in the Result Text Message field. This is the message returned by Services Australia, and shows why the transmission failed.
  3. If the error was an internet connection error, when your internet is working, submit the claim again:
    1. Click Edit iconEncounter or click the yellow triangle (View Claim details) to display the Service Record window.
    2. Click Claim now again.

The claim is prioritised and is submitted electronically to Medicare Online immediately.

If the error describes a problem with your provider number or other problems, resubmit the claim. See below for more information.

Checking if a claim has been accepted or rejected by Medicare Australia

All claims transmitted using online claiming have up to three stages: Sent, Processed, Paid. After a claim is sent it generally takes 1-3 days to be processed, but in some cases, if there are problems it can take a week or longer to be processed.

Resubmitting claims with a status of Claim sent - Awaiting processing

To resubmit claims with a claim status of Claim sent - Awaiting processing:
  1. Wait until at least 7 days have passed since you submitted the claim.
  2. For a claim that has a claim status of Claim sent - Awaiting processing, call Medicare on 1800 700 199 to confirm that they did not receive the claim. If they did receive claim, do not complete these steps.
  3. If Medicare definitely did not receive the claim, click Reset Bulk Bill. The Reset action deletes all information about the online claim for this encounter in Communicare. If the claim was received by Medicare Australia, but has not yet processed and you reset it, the claim might eventually be paid by Medicare, but Communicare will not record this information.
  4. Click Encounter.
  5. In the Service Record window, fix any problems.
  6. Click Claim now.

The claim is prioritised and is submitted electronically to Medicare Online immediately.

Resubmitting claims with a status of Claim rejected - View Report

To resubmit claims with a status of Claim rejected - View Report:
  1. For a claim that has a claim status of Claim rejected - View Report, click View Medicare Australia Report.
  2. Review the report.
  3. For the rejected claim, click Encounter.
  4. In the Service Record window, fix any problems.
  5. Click Claim now.

The claim is prioritised and is submitted electronically to Medicare Online immediately.

Resubmitting partially paid claims with a status of Claim partially paid by Medicare Australia

To resubmit claims with a status of Claim partially paid by Medicare Australia:
  1. In the encounter list, select the encounter.
  2. Click Encounter.
  3. On the Service Record > Medicare tab, some items will display a red cross icon and some a green dollar icon. The green dollar indicates a paid item, which cannot be edited. The red cross icon indicates a rejected item, which can be edited.
  4. Correct the items with a red cross. Do not deselect the rejected items until you have claimed the additional items. This approach ensures that the claim remains in the Bulk Bills Claims tab until it is fully paid.
  5. Click Claim now.

A new claim is generated for all items in the original claim that were not paid.

The claim is prioritised and is submitted electronically to Medicare Online immediately.

If the original claim now contains only paid items and unsent or reset items, it is considered to be fully paid.

Frequently Asked Questions

  • Q: Why doesn't the Show paid claims filter work?

    A: Click Apply Filters after selecting a filter to apply it to the encounter list.

  • Q: Why can't I reset a rejected claim using the Reset Bulk Bill button?

    A: This button is used only to reset a claim that is being ignored by Medicare. Resubmit a rejected claim for it to be resent.

  • Q: Why can't I see the provider names in the encounter grid?

    A: There can be multiple claiming providers on a single encounter so providers are displayed in the claims grid. Use the Filter Provider option to hide all encounters except those for a specified provider.

  • Q: How do I check the status of a claim from the Service Record?
    A: Edit the service details and change to the Medicare tab. If there is no icon next to an item it has not been sent or is still in the queue. The icons that may appear are:
    • Claim pending
    • Claim rejected
    • Claim paid