Integrations and Add-ons

Connect and automate your business with other tools and features.

Submitting an Online Claim for Medicare and DVA

This article explains how to submit claims for Medicare or DVA.

Make sure the Medicare integration has been set up and the relevant forms have been sent to Medicare to link provider numbers to Minor ID otherwise all claims will be rejected.

See Setting Up Online Claiming more help.

To submit successful claims, in addition to an appropriate setup, it is important to:

  1. Ensure that each client has a Medicare and/or DVA number that has been saved and verified in the Health section of the Client’s Profile
  2. Attribute the invoice to the appropriate Case in which the Medicare has been added as the Payer and the referring GP/provider number and referral date in the referral field. See Setting Up a Medicare EPC or CDM Case for all the details.

Online claims are added to a queue and are generally processed overnight.

There are 2 ways to submit a claim:

    • While generating a new invoice by ticking the “Add to Medicare Queue” field before saving the invoice.
    • By opening an existing invoice and clicking the Online Claim button.

Claims are automatically marked as Client Reimbursement if there is at least one payment (of any value) on the invoice.

If there is no payment made on an invoice, the claim will be automatically marked as Bulk Bill.

Submitting an Online Claim at the Time of Invoicing

1. Click on Generate Invoice in the appointment screen.

2. Tick Add to Medicare Queue.

The Client’s Medicare card has not been verified. Go to Client’s Health section.

3. Click on Save Invoice.

4. In the pop-up box that opens, ensure the Item Code and Claim amount are correct.

The item Code needs to be exactly the one Medicare or DVA provide otherwise the claim will be rejected.

5. Select the appropriate Provider Number for the Provider that match the Location or Claiming Group (Minor ID).

6. Tick the box of the Item(s) to claim.

You can add multiple items to an invoice to claim them at the same time to reduce online claiming fees.

7. Click Submit Claim.

8. In the small pop-up window that opens, select a Claim Type.

  • Medicare Bulk Bill: For unpaid items – payment will be sent to the nominated practice bank account.
  • Medicare Client Reimbursement: For paid items, the Client will receive the payment.
  • DVA claim: Payment will be sent to the nominated practice bank account.

9. Select the Consultation Type of Location.

10. Select the appropriate Referral (GP and provider number with the referral date) or select “No Referral Required” as appropriate.

11. Click Submit.

The Claim will be queued and usually processed overnight by Medicare/DVA.

 

Claiming for an Existing Invoice

1. Find and open the Invoice.

2. Click Online Claims.

3. On the pop-up window that opens, follow steps 4 onwards from the section above.

Cancelling an Online Claim

Claims can only be cancelled while they are in the queue to be processed – once processing begins, you will need to wait for Medicare / DVA to process the request.

To cancel a claim that has been placed in the queue, open the client’s invoice, click the View Online Claim Status button, select the items to cancel, and click “submit”.

Reviewing Online Claims

To see a list of submitted claims for a specific period, simply visit Reports > Financials > Medicare and run the report for the chosen time period, Locations, Claiming group, Providers, etc.

Remember: The status of each claim is generally updated overnight.

This information is correct at the time of writing. Always check with Medicare as to how your clinic should make its claims.

Help Centre

Looking for Answers?

All that is gold does not glitter, but Helga's here to help those that may be lost.