Patient Claims - Interactive

Use the Claims Status (Online Claiming) > Patient Claims tab to manage interactive patient claims to Medicare.

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.

Patient claim encounter list

The patient claim encounter list shows all encounters for which an invoice has been generated and the patient claim has been transmitted to Medicare.

For each encounter, the following information is displayed:
  • Invoice no. - the invoice number.
  • Encounter Date and Time - the Start Date and Time on an encounter. If date only is used then this is the date of the encounter.
  • Claim ID - unique identifier for a given month, which together with the date, identifies a claim within the online claiming system
  • Patient Name - name of the patient for whom the claim is submitted. The patient's HCH Tier detail is highlighted if the patient is registered for HCH and the Tier is recorded.
  • Claimant Name - claimant for the claim.
  • Claim Status - current state of the specific claim.
    A patient claim can have one of the following states:
    • Accepted
    • Batch Claim
    • Accepted - Pending Assessment
    • Rejected
    • Deleted
    • Discarded - when a rejected claim is retransmitted, the original claim is discarded
  • Provider Name - service provider name

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@.
    • Encounter Place - select an encounter place from the list to display claims only for a specific Encounter Place
    • 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.
    • Claim Status - select to display only those claims with a particular status
    • Invoice No - enter a value to display a claim associated with a particular invoice number
  2. Click Apply Filters.

Only those encounters that meet the filter criteria are displayed.

To display all encounters again, click Reset Filters.

Claim details

Select a claim in the claim list to display details about that claim:
  • Result Text Message - details of an attempt to send a claim, including reasons for failure to send.
  • Minor Location ID, Provider Number, Payee Provider Number
  • Transmission Date - the Date and Time when this claim was transmitted to Medicare Australia

Medicare reason codes

You can look up a Medicare reason code at http://www.medicareaustralia.gov.au/provider/vendors/reason-codes/medicare.shtml.