Submit a claim to Medicare

If your health service is integrated with Medicare, you can submit an electronic claim either when you close a service if you are the provider, or later if you are a receptionist or claims manager.

If the service is not claimable, set This service is not claimable and click Save iconSave, or click Save iconNot claimable.
Select an MBS item and then add the details for that specific item. You can set a different provider for each item.
Tip:
If a clinical item used in the service is linked to an MBS item for your site, the item is selected automatically.
To submit a Medicare claim:
  1. Open the Service Record window.
    • If you are the provider and you are submitting the Medicare claim:
      1. In the Clinical Record, click Close iconClose.
      2. Click Yes - This service is now complete or No - Patient will see another provider.
    • If you are the receptionist:
      1. Click Service Recording iconService Recording.
      2. In the Service Recording window, double-click the patient for whom you want to submit a claim.

    Example Service Rrcord window
  2. In the Service Record window, on the Medicare tab, check that the provider listed as Default Claiming Provider is correct (listed above the Claim now button). If the provider is incorrect, on the Detail tab, select the correct provider.
    Tip:
    In the Service Record, for patients whose Medicare Card details are incorrect or incomplete, a Incomplete Medicare details iconMedicare Incorrect icon with a red slash through it is displayed. To validate the patient's Medicare details, click Incomplete Medicare details iconMedicare Incorrect. For patients with a valid Medicare card or whose details have been verified with Services Australia but with suggestions, no icon is displayed.
  3. Review the information that relates to all items claimed.
    • To view or edit administration notes related to the claim, click Edit admin notes for the claim iconAdmin notes.
      Tip:
      This is useful for doctors to add claim notes for the claims administrator.
    • If enabled, to claim the items as an Inpatient Service, select Inpatient.
  4. To display previous items that have been marked for claiming for this patient, whether they have been paid or not, click MBS Items HistoryMBS Items History.
  5. In the list of items, select an item. Most common MBS items are listed.
    • If the item you want to claim is not listed, either:
      • If you know the number of an item which is not listed, in the Claim another MBS item field, enter the number and click Add iconAdd.
      • Search for an item:
        1. Click Search MBS items iconSearch.
        2. In the Search MBS Items field, enter a search term. For example, pregnancy.
        3. In the list, select an item and click Select. The item is added to the list in the Service Record window and is selected.
    • If you want to claim an item more than once, right-click the item and select Add this MBS item again.
    • If you want to claim an item that does not have a simple fee (such as a home visit), right-click on the item and select Display the derived fee description for this MBS item. Using the description, fill in the details required (for example, amount claimed, number of patients seen, and so on).
  6. Below the list of items, select the details that apply specifically to the selected item:
    • In the Amount Claimed field, if the amount you want to claim for this item is different to the default, enter the correct amount.
    • If this item was provided by a location-specific provider, such as an x-ray machine, in the LSPN field, enter its number.
    • From the Provider list, select the provider who is claiming the selected MBS item if different from the default provider listed above the buttons.
    • You may need to provide other information specific to your health service in the other optional fields, including:
      • Service Text
      • Number of patients seen
      • Field Quantity
      • Self Deemed
      • Override Type
      For more information about these fields, see Education guide - Medicare Online data elements
    • If the item being claimed requires details of a referring provider, select the item, select Specialist Services and do one of the following:
      Note:
      Referral details are only included once for each claiming provider, so select only one item per specialist claiming provider.
      • Complete the specialist's and the referral details
        • To add details of the last referring provider for the patient, click Use last referrer.
        • If the referral has a custom referral period, from the Referring Period Type, select Non-standard and enter the referral period in the Referral Period field.
      • From the Override Type list, select an override type:
        • Lost - do not provide any referring provider or referrer information.
        • Emergency - do not provide any referring provider or referrer information.
        • Hospital - also set Inpatient which includes the Hospital Facility ID for the encounter place in the claim. Do not provide any referring provider or referrer information.
        • Referral Provider Details will be submitted - include a referring provider number and submit the referral separately.
        Tip:
        If Specialist Services is selected and details are complete, a Referral information completegreen dot is displayed in the Referred column for the claim item. If it has been selected, but some details are missing, a Referral details incompleteyellow dot is displayed.
    • You can also set whether an item is Not normal aftercare items, Not duplicate service or Not multiple procedure.
  7. Repeat steps 5 - 6 for each item, changing the provider if required.
  8. When you are confident that the items to claim are correct, click Save iconClaim now.
    If you have MBS incentive items set for your organisation or encounter place, for eligible patients you are automatically prompted to also include the incentive item appropriate to your region. In the Confirm window, click Yes.
  9. In the Bulk Bill - Electronic Claims window, review the bulk bill details and click Accept.
The patient's clinical record is closed.

The claim is queued to submit electronically to Medicare Online when CCareQueue_ServicesAustralia next runs.

If you submitted a claim incorrectly, correct it as quickly as possible. See Correcting Medicare Claims for more information.

In the Service Record window, on the Medicare tab, next to each item claimed there is an icon showing its status. These icons are also displayed when you open the Service Record from the Online Claiming window:
  • Claim sent or claim pending
  • Claim rejected
  • Claim paid

Check details of Medicare claims on File > Online Claiming > Bulk Bill Claims tab. For more information, see Bulk Bill Claims (Online Claiming).