The Insurance tab is where you enter all Insurance/third party payer details for the Client.
The information held in the Insurance tab includes:
In the top section ...
- Medicare
- Department of Veteran Affairs (DVA)
- Pension or Health Care Card (HCC) Holder
- Default Billing Rate
In the bottom section (Select Add or press CTRL+A) to add ...
- If no detail is entered here or if expiry dates are before the Date of Service, you can only generate a private invoice
Medicare
- Ensure Medicare Australia Online is setup correctly
- Select Is Covered to open the form
- Key-in the Medicare Number or select the Card Reader button if you have a Card Reader
- Enter Position on Card (optional)
- Do not enter a Valid to Date. Why? On verifying with Medicare, it is only verified at that point in time. Medicare verification only refers to the Firstname, DOB and Card Number. If you do enter a Valid to Date and the patient returns at a later date, you will not have the option to Bulk Bill until you change this Valid to date to a date in the future. Some Health Funds require a date here for verification. If so, enter a year well into the future (eg: 2020)
- Select Verify
- If all OK, the font on the Verify button will change to green
- If details differ to those that Medicare has, you will be informed of this and prompted to update them
- Should you have no Medicare Number, select the H-POS (Health Provider Online Service) button on the sidebar Click on the link to set up HPOS - Services Australia
- On invoicing, you now have the option to select the Rate Bulk Bill, resulting in being able to transmit this invoice directly to Medicare for processing if the Practitioner has nominated this Rate in the Entity Setup for that Location
Pension/HCC
- Complete the steps above for Medicare verification
- On doing so, you will be informed if the Client is Concession Eligible
- If you are wanting to charge a pension rate to a patient that doesn't have an eligible card, put in Y or Yes where the card number goes to enable the pension rate when invoicing.
DVA
- Ensure Medicare Australia Online is setup correctly
- Select Is Covered to open the form
- Select Veteran Type
- Select Verify. No need to enter the Veteran Number as on verification, Medicare will populate the correct Number and the Veteran Card Type. Click on the Veteran Card | Department of Veterans' Affairs (dva.gov.au) link to find out more about card types
- Gold
- Orange
- White ... if White, you will be prompted to enter the Accepted Disability
- If all OK, the font on the Verify button will change to green
- If details differ to those that Medicare has, you will be informed of this and prompted to update them.
- On invoicing, you now have the option to select the Rate DVA In Room and DVA In Hospital, resulting in being able to transmit this invoice directly to Medicare for processing if the Practitioner has nominated this Rate in the Entity Setup for that Location
Default Billing Rate
Selecting the Default Billing Rate will not put that rate on the invoice unless the other relevant detail is entered. E.g. Is covered, DVA Number and Card Type.
To ensure the rates are accessible in each entity go to sub-section Medical Services in article Clients - Transactions: Insured Invoices (zendesk.com)
Drop down menu with the rates that can be selected
- Bulk Bill
- Cosmetic
- DVA Allied Health
- DVA In Hospital
- DVA In Room
- Insured
- Overseas
- Pension HCC
Private - Private Custom 1
- Private Custom 2
- Private Custom 3
- Uninsured
- Workcover
Private Health Insurance
- Complete the steps above for Medicare Verification
- Select Add on the sidebar or press ALT+A to open the form to enter Private Insurance details
- Select the Group the fund is in
- Select the Fund
- Should this be a new fund, select [...] to go to Contact Mangement - Insurers/Companies and add the new Fund Detail
- Enter the Membership Number
- Select Verify resulting in both the Medicare Number being verified again and verifying if this Client's Insurance is current. If there is any discrepancy, you will be prompted to contact the Health Fund
- This verification only verifies if the Client's Insurance is current
- Once verified, a button will appear to create and IFC and do an Online Eligibility Check (OEC) if the fund does this (refer to Private Health Insurers’ functions and contact details - Simplified Billing and ECLIPSE - Services Australia)
- On invoicing, you now have the option to select the Rate Insured, resulting in being able to transmit this invoice directly to Medicare for processing if the Practitioner has nominated this Rate in the Entity Setup for that Location
- A Client can only have one Current Health Fund
- Should they change Health Funds, do not edit the old one. Add a new one and make it current leaving the old one there for history
- You cannot delete a Health fund from here if it has been referenced on and IFC or Invoice
- A Client can have one Current Health Fund and Current Workcover and Current Other / Third Party Payers and Medico Legal
- Details of this is displayed in the top of the Client Record to include Insurer Phone numbers
Online Eligibility Check (OEC) and Informed Financial Consent (IFC)
- Select OEC button to complete an Online Eligility Check resulting the OEC report displaying on screen and saving as a PDF in Client Communication
- Select IFC button to complete and Informed Financial Consent that on printing to Word also saves as a PDF in Client Communications. An OEC can be completed from the IFC form as well
WorkCover
- Select Add on the sidebar or press ALT+A to open the form to enter Workcover details
- Select the Group WorkCover
- Select the WorkCover Agent
- Should this be a new agent, select [...] to go to Contact Management - Insurers/Companies and add the new Workcover agent
- You will note that the form changes to capture detail about the Claim
- Enter the Assessor Claim Number
- Select the Injury Date
- Select a Contact/Case Manager. If not in the list, go back to the [...] button and add the Contact there
- On invoicing, you now have the option to select the Rate WorkCover, if the Provider has nominated this Rate in the Entity Setup for that Location
- A Client can only have one or a number of Current Work Cover Claims
- A Client can have one Current Health Fund and Current WorkCover and Current Other / Third Party Payers and Medico Legal
- Details of this is displayed in the top of the Client Record to include Insurer Phone numbers
Medico Legal
- Select the Medico Legal tab
- Select Add on the sidebar or press ALT+A to open the form to enter Medico Legal details
- Enter the Claim Number
- Select the Solicitor
- Should this be a new Solicitor, select [...] to go to Contact Management - Solicitors and add the new Solicitor
- Enter the Assessor
- Select the Injury Date
- On invoicing, the Rate to use is Private but you change the Payer to be the Solicitor
- A Client can only have one or a number of Current Medico Legal Claims
- A Client can have one Current Health Fund and Current Workcover and Current Other / Third Party Payers and Medico Legal
- Details of this is displayed in the top of the Client Record to include Phone number
Other Third Party
- Select Add on the sidebar or press ALT+A to open the form to enter Third Party Payer details
- Select the Group Other
- Select the Third-Party Payer
- Should this be a new Payer, select [...] to go to Contact Management - Insurers/Companies and add the new Payer Detail
- In the Membership Number you could enter a Purchase Order number
- On invoicing, you now have the option to select the Rate Insured if the Provider has nominated this Rate in the Entity Setup for that Location
- A Client can only have one or many Third-Party Payers
- Details of this is displayed in the top of the Client Record to include Insurer Phone numbers
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