Checking 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 Services Australia

To find all claims that have not been transmitted:

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.
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.
If the error was an internet connection error, when your internet is working, submit the claim again:
1. Click Encounter or click the yellow triangle (View Claim details) to display the Service Record window.
2. Click Claim now again.

Claims are sent at the interval and times configured in CCareQueue_ServicesAustralia. By default, claims are sent hourly, 12:00-1:00pm. For more information, see Services Australia interaction defaults.

If the error describes a problem with your provider number or other problems, resubmit the claim. For more information, see Correcting Medicare Claims.