Requirements

• Provider/Entity is registered with Medicare - Pre-requisites
• Provider/Entity has Private or Pension/HCC or other Custom Rate selected in Location rates for each Active Location in Utilities - Entities - Locations (Active)
• Patient/Client has a valid/verified Medicare Card
• If the Provider/Entity is an Allied Health Provider or a General Practitioner, a Referral is not required
• If the Provider/Entity is a Specialist a current Referral is required unless an override is selected
• DCM will not process a Patient Claim (PC) if any of the above is not correct
• On transmitting the Claim, the Medicare Card is verified again based on the Date of Service (DOS)

Invoicing

Patient Claims cannot be lodged if the Date of Service (DOS) is older than six months.

Should this be the case, any existing invoicing with DOS over 6 months that has not been sent as a PC, will need to be sent to the patient for them to claim.

If you are a Billing Agent, you need to instruct your clients that for patients with no private insurance to prepay for all services. If circumstances do not allow this, ensure they do not delay in informing you of claims so you can lodge them within the DOS of 6 months.

Unpaid Invoices

• On generating the Invoice with the Rate Private or Pension/HCC or other Custom Rate, a button labelled Patient Claim will appear on the on the sidebar to select to transmit if it has not been disabled in IHC / Medicare – Direct CONTROL Medical (DCM)
• Transmitting a PC from an unpaid invoice currently results in a cheque from Medicare being sent to the Patient and made out to the Provider. The Patient needs to send this cheque to the Provider. If they do not, Medicare will deposit the payment directly to the Provider's Bank Account after 90 Days ... 90 day pay doctor cheque scheme - Health professionals - Services Australia
• If the Billing Entity is not a GP, the Benefit is 85% of the Medicare Fee Schedule for an In Room Service and 75% of the Medicare Fee Schedule for an In Hospital Service
• If the Billing Entity is a GP, the Benefit is 100% of the Medicare Fee Schedule be it an In Room or In Hospital Service
• Right-click on the Item Description to select any Qualifiers that Medicare/DVA require

Receipting 

• The Invoice can be receipted in full, or the patient can pay the OOP only
• If paying the OOP only, then currently this results in a cheque from Medicare being sent to the Patient and made out to the Provider. The Patient needs to send this cheque to the Provider. If they do not, Medicare will deposit the payment directly to the Provider's Bank Account after 90 Days ... 90 day pay doctor cheque scheme - Health professionals - Services Australia
• If the patient pays in full, they will receive the rebate to their nominated bank account

• On Receipting the Invoice with the Rate Private or Pension/HCC or other Custom Rate, a button labelled Patient Claim will appear on the on the sidebar of the Receipt to select to transmit

Statement of Benefit or Lodgement Advice

• On transmitting, either a Statement of Benefit or a Lodgement Advice will appear on screen and is saved to Client Communications
  • The Statement of Benefit confirms that the Patient Claim has been approved
  • The Lodgement Advice confirms receipt of the Claim, however, it has been passed on to be approved. This may occur should the patient have reached their Safety Net

Patient Claim (Interactive) Error Codes

Look up Medicare Online and ECLIPSE return codes - Health professionals - Services Australia