Claiming Medicare (Doctor)

If your health service is integrated with Medicare, you can submit an electronic claim when you close a service if you are the provider.

To submit a Medicare claim when you close a service:
  1. In the Clinical Record, click Close iconClose.
  2. Click Yes - This service is now complete or No - Patient will see another provider. You can claim for your portion of the service in either case.
  3. If you need to check a patient's Medicare details, call Medicare Indigenous Helpline 1800 556 955 or Medicare Card enquiries 132 150.
  4. In the Service Record window, on the Medicare tab, check that you are listed as the Default Claiming Provider. If not, on the Detail tab, select your name.

    Default claiming provider in Service Record
  5. 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.
  6. In the list of items, select those that you want to claim. 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.
  7. If you want to claim an item more than once, right-click the item and select Add this MBS item again.
  8. 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.
  9. If the item being claimed requires details of a referring provider, select the item and select Specialist Services and complete the specialist's details.
    • To add details of the last referring provider for the patient, click Use last referrer.
    • The Referred field on the far right of the grid indicates whether an item has Specialist Services selected. If it has been selected and details are complete, a green dot will be displayed. If it has been selected, but some details are missing, a yellow dot is displayed. No image is displayed if Specialist Services is not selected.
    Note:
    Referral details are only included once per claiming provider, so select only one item per specialist claiming provider.
  10. To view or edit administration notes related to the claim, click Edit admin notes for the claim iconAdmin notes.
  11. If enabled, to claim the items as an Inpatient Service, select Inpatient.
  12. When you are confidant that the items to claim are correct, click Claim now.

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 Communicare is configured to print, an Assignment Form is printed for the patient to sign.

In the Service Record window, on the Medicare tab, next to each item claimed there is an icon showing its status:
  • Claim pending
  • Claim rejected
  • Claim paid

If you clicked Claim Later, the claim is stored so it can be claimed later.

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

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