Electronic Claims Reports
Use the electronic claims reports to manage Medicare claims and payments.
| Description | |
|---|---|
| Batched By Period | Displays a list of online claims for a selected date range that are
associated with multiple services, and includes reference, date, patient
name and status. Fictitious patients and withdrawn services are excluded. |
| Bulk Bills Status | Shows all the records visible in the tab for claims that are associated with a single service,
and includes details of patient Medicare card status and any error
messages that are reported when attempting to send. Paid claims and
discarded claims are excluded. Export the report to Excel for analysis. Use the report to assist in the maintenance and monitoring of the Bulk Bill Status for claiming purposes. |
| By period | Displays a list of online claims for a selected date range that are
associated with a single service, and includes reference, date, patient
name and status. Fictitious patients and withdrawn services are excluded. |
| CDM Summary for Selected Patient | Enables you to keep track of Chronic Disease Mangement (CDM) claims
for a selected patient. The report shows all claims within the last 18 months that are associated with a single service, for GP management plans (721), team care arrangements (723), reviews (732), Aboriginal health assessments (704 to 710 and 715), Aboriginal health check referrals (10987) and follow ups (10997) and any items from groups Allied Health Services (M3), Allied Health Group Services (M9) and Allied Health Services for Indigenous Australians who have has a health check (M11). The following COVID-19 MBS items are
included as equivalents of the health assessment and chronic disease
management items:
Where there have been no claims in the last 2 years nothing to report is shown. |
| CDM Summary Patients with current 723 | Enables you to keep track of Chronic Disease Mangement (CDM) claims
for patients with a current paid claim for a 723. The report shows all claims within the last 18 months that are associated with a single service, for GP management plans (721), team care arrangements (723), reviews (732), Aboriginal health assessments (704 to 710 and 715), Aboriginal health check referrals (10987) and follow ups (10997) and any items from groups Allied Health Services (M3), Allied Health Group Services (M9) and Allied Health Services for Indigenous Australians who have has a health check (M11). The
following COVID-19 MBS items are included as equivalents of the
health assessment and chronic disease management items:
|
| Check Items and Claims | Use this report to cross check completed procedures and immunisations
performed with Medicare claims associated with a single service. Only services with the selected procedures or immunisations are included. Claims by all providers on the service are shown. Use this report to specify a specific procedure or immunisation (or all) that normally attracts a Medicare claim to see if 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. |
| Claims and Payments by Provider | Shows selected providers who have claimed MBS items during a selected
period and shows the number of claims made, the amount claimed and the
amount already paid by Medicare Australia. This report includes only
claims that are associated with a single service. The figures are broken down by whether the service for which the items were claimed was in or out of normal clinic hours for weekdays, Saturdays and Sundays. Results can be filtered by Encounter Place and Encounter Program. |
| Claims on Behalf of a Doctor | For claims that are associated with a single service, displays names
of providers associated with a service in which an item was claimed on
behalf of a medical practitioner, including all items in the
Miscellaneous category groups of items claimed by a nurse or by an
aboriginal health worker on behalf of a medical practitioner. Use the report to see which nurses and healthworkers are claiming on behalf of a doctor. Medicare Plus items are not included in the report. The report looks for items selected for claiming - claims may or may not have been sent, paid or rejected. |
| Claims on Behalf of a Doctor by Client | For claims that are associated with a single service, displays names
of clients and dates of service for services in which a Medicare claim
was made on behalf of another medical practitioner, including all items
in the Miscellaneous category groups of items claimed by a nurse or by
an aboriginal health worker on behalf of a medical practitioner. The report looks for items selected for claiming - claims may or may not have been sent, paid or rejected. |
| Claims on Behalf of a Doctor Missed | For claims that are associated with a single service, lists all services where a Medicare claim item has been selected but there is no claiming doctor on the service. Use this report to find services where a potential claim may be lost because a claiming doctor has not been added to the service. For example, a nurse may have ticked item 10993 after performing an immunisation but forgotten to add the doctor's name to the service. |
| Daily Claim Activity | For claims that are associated with a single service, lists the
number of encounters, the number of encounters actually claimed and the
value of the claims by provider and day for the selected period,
assuming that all claims will be processed and paid. Services that are
not claimable are not counted by this report. Use this report to check that services are being claimed and to analyse claim activity. |
| EFT payments | For claims that are associated with a single service, displays a list
of payments made by Medicare Australia, for a selected range of dates,
including date, run number, payee provider number and amount paid. Use this report to reconcile bank account statements. Claim Status: This report may differ from other electronic claims reports because it only reports on claims that have been paid by Medicare. |
| For Selected Item Number | For claims that are associated with a single service, displays a list of names of patients for whom a selected MBS item has been claimed for a selected date range, including patient, MBS Item Number, Amount Claimed and Amount Paid. |
| Items Claimed by Providers by Date | For claims that are associated with a single service, displays a list
of MBS Item Numbers (online claims) that have been claimed, processed or
paid by HIC, for a selected date range, including Provider, MBS Item
Number, Amount Claimed, Count. The report groups by Provider showing the number of times each item was claimed and the total amount claimed for that item. Claims that are still in the queue or have encountered a transmission error will not be included until they have been successfully sent. Rejected claims are also excluded. For these reasons, don't run this report with a very recent Last date to report such as TODAY. |
| Items Claimed Count by Date | For claims that are associated with a single service, counts the
number of times each MBS item has been claimed during a selected date
range, including MBS Item Number, MBS Item description and the number of
times claimed and total amount claimed. Use this report for an overview of claim activity, such as the number of health checks claimed. Filter by encounter place, mode and program. Claims that are still in the queue or have encountered a transmission error will not be included until they have been successfully sent. Rejected claims are also excluded. For these reasons, don't run this report with a very recent Last date to report such as TODAY. |
| Medicare number validation status | Analyses the HIC online validation status of all patients in the
Communicare database. Use this report to detect when additional Medicare validation is required. |
| Outstanding claims | For claims that are associated with a single service, shows all
patients with an outstanding Medicare claim where the claim is within
the last two years. The services reported are those where items have been selected and Claim Now has been clicked but the claim has still not yet been sent. |
| Partially paid by period | For claims that are associated with a single service, displays a list of Electronic Claims that have been partially paid by Medicare Australia, for a selected date range, including Claim ID, Service Date and Time, Patient Name, Provider Name, Amount Claimed, Amount Paid, Payment Date and Run Number. |
| Partially paid with erroe message | For claims that are associated with a single service, displays a list
of Electronic Claims that have been partially paid by Medicare
Australia, for a selected date range, including Claim ID, Service Date
and Time, Patient Name, Provider Name, Amount Claimed, Amount Paid,
Payment Date and Run Number. If required include fully rejected claims or show only discarded claims. |
| Payment Run Number Details | For claims that are associated with a single service, displays a list
of Electronic Claims that have been paid by Medicare Australia, for a
selected payment run number, including reference, date, patient name,
provider, amount claimed and amount paid, grouped by Payee Provider
Number and Servicing Provider showing total amount claimed for each
provider. Use this report to see the details of a payment run number. |
| Payment Transaction List | For claims that are associated with a single service, displays a list
of payments made by Medicare Australia for a selected date range,
including Payment Date (the date when Medicare Australia made the
payment), Payment Run Number, Payee Provider Number, Transaction
Reference and Amount Paid. Use this report to reconcile Communicare's payment records to your bank statement. |
| Payment Transaction List Reconcile | For claims that are associated with a single service, displays a list
of payments made by Medicare Australia for a selected date range showing
only those payments that have services done outside the reporting
interval, including Payment Date, Payment Run Number, Payee Provider
Number, Transaction Reference and Amount Paid. The Payment Date is the date when Medicare Australia made the payment, which is typically one working day before the payment appears on your bank statement. Use this report to find out how many claims were paid in the reporting period that were performed outside the reporting period or were paid outside the reporting period but were performed inside the reporting period. This is useful when reconciling the services performed with the amounts paid.
All positive amounts paid are claims paid within the reporting period and performed outside the reporting period. All negative amounts paid are claims paid outside the reporting period and performed inside the reporting period. |
| Provider Activity | For claims that are associated with a single service, shows a
provider's claim summary for all services between two dates. It is similar to the Service Recording window but individual MBS items and their statuses are shown. |
| Rejected by Period | For claims that are associated with a single service, displays a list
of Electronic Claims (Online Claims) that have been rejected by
Medicare, for a selected date range. Partially rejected claims are also
reported. The report shows reference, date, patient name, provider and amount claimed. |
| Service Activity Report | For claims that are associated with a single service, displays a
comprehensive summary of all items claimed using Medicare's online
claiming. Individual claims are shown with date, place, doctor, item
number and amounts claimed and paid. If required, select claims only for
services flagged as after hours. Export the report to Microsoft Excel and manipulate it to extract detailed information concerning claims and payments. |
| Service Provider Duration and Claims | Shows the duration of services recorded for a selected provider
between two dates with details of Medicare items claimed. Use this
report to audit length of consultations with Medicare items
claimed. The duration will be the time the clinical record was open for that provider unless it has been manually adjusted. Only services with Medicare claims are included (whether paid or not paid). No client contact services are excluded. Services with no length are excluded (for example, the claimant was added to the service but did not open the clinical record). |
| Services Claimed by Encounter Plc (Totals) | For claims that are associated with a single service, displays total
Medicare revenue for each encounter place for a date range, including
Provider Name, Total Amount Claimed, Total Amount Paid. Use this report to obtain total Medicare revenue figures for each provider. |
| Services Claimed by Provider (Details) | For claims that are associated with a single service, displays a list
of services between a date range, that have been claimed, including
Claim ID, Service Date, Patient Name, Amount Claimed, Amount Paid,
Payment Date and Payment Run Number, grouped by Provider. Use this report to obtain Medicare revenue figures for each provider. |
| Services Claimed by Provider (Totals) | For claims that are associated with a single service, displays total
Medicare revenue for each provider for a date range, including Provider
Name, Total Amount Claimed, Total Amount Paid. Use this report to obtain total Medicare revenue figures for each provider. |
| Services Claimed for Patient | For claims that are associated with a single service, displays a list
of services between a date range, that have been claimed for a patient
and includes Claim ID, Service Date, Amount Claimed, Amount Paid,
Payment Date, Payment Run Number and Provider. Use this report to obtain Medicare billing figures for a selected patient. |
| Services Not Claimed by Period | For claims that are associated with a single service, displays a list
of Services that have not been claimed from Medicare, for a selected
date range and includes reference, date, patient name and amount if
any. Use this report to get a list similar to the one visible in tab. The report identifies services that should be claimed or marked as not claimable. |
| Services Not Claimed by Provider | For claims that are associated with a single service, displays a list
of Services that have not been claimed from Medicare, for a selected
date range and includes reference, date, patient name and amount if any,
grouped by place, mode and provider. Use this report to identify services that should be claimed or marked as not claimable. |
| Services Not Processed by Period | For claims that are associated with a single service, displays a list of electronic claims sent but not processed for a selected date range and includes reference, date, patient name and status. |
| Services Paid by Period | For claims that are associated with a single service, displays a list
of services between a date range that have been paid by Medicare
Australia, including those partially paid. It shows Claim ID, Service
Date, Patient Name, Provider Name, Amount Claimed, Amount Paid, Payment
Date and Payment Run Number. Use this report if you want to export the list of all claims to Microsoft Excel. |