Covering the below

• Pre-requisites
• Setup
• The Hospital Billing Entity
• Entering and maintaining Health Fund Contracts
• Pre-Admission and Theatres Non-Billing Entities
• Overview
• Setup
• Workflow

Pre-requisites

• Ensure detail is setup and Health Fund Contracts are entered. Here is a document for your reference ECLIPSE Online Hospital Claiming User Guide (servicesaustralia.gov.au)
• Also visit Provider Resources | Private Healthcare Australia (PHA)
• You have completed the necessary paperwork for Medicare
  • Hospital or day procedure centre registration for in hospital claiming form (HW025) - Services Australia
  • Banking details online claiming form (HW052) - Services Australia
• You have informed the Health Funds that you will be transmitting In Hospital Claims. 
• Check which Health Funds participate and what products/services they offer. Private Health Insurers’ functions and contact details - Simplified Billing and ECLIPSE - Services Australia and also the AHSA Fund list at Fund List - AHSA
• Go to Contact Management – Insurers/Companies and check that the Participant/Fund Brand ID is entered in the HOS: field for each Health Fund that accepts IHC Online. The IHC button will not appear on the Admission form unless this field is populated
• You have the 3M Grouper installed to return the DRG
• Consider onscreen signing of the NPPHC form. Recommend you purchase a WACOM sign pad for onscreen signing of the NPPHC and DVA forms. These forms are then saved to the Client’s record in Communications.

Setup

• Ensure that business details, business locations and non-MBS Item Codes are setup before setting up the Hospital (Billing Entity) and Theatres (Non-Billing Entity).
  • See article in Use Direct CONTROL Desktop version - Utilities - Business Details for both Business Details and Business Locations
  • For Adding Accommodation Item Codes and Prosthetics: See article in Setup Direct CONTROL - Manage Item Codes and Fees 

• Referencing the above formats (ACCS1AMP, etc) and the Patient Classification Codes and Bed Level Codes below, you can formulate your own codes based on your Health Fund Contracts

The Hospital Billing Entity

• Double click on an existing Entity to edit or select Add on the sidebar to add a new Entity
• Health Fund contracts are entered and maintained in the Location Rate Insured by selecting the green Edit button
• Fees for patients without Private Health Fund Insurance are entered and maintained in the the Location Rate Uninsured by selecting the green Edit button. Even though there is no Medicare Rebate, these fees can be based on existing fee schedule (eg: AHSA) or a percentage of

Entering and maintaining Health Fund Contracts

• Select Use check box on the Insured Rate line to activate
• Select the green Edit button
• The Entity Insured Rates form is divided into two sections
  • The top section is where you add and maintain Item Codes per Insurer Group and the contracted fee
    • These Item Codes need to be in Utilities - Lookups - General - Items before you can select them in here
      • MBS Item Codes are maintained by DCM
      • ACC1 through to ACC4 for Same Day / Day Surgery are already in DCM, as are
      • Band1a through to Band9
        • On entering an MBS Item Code on the IFC or Invoice, DCM will populate the correct fee based on that Item Code's banding
    • Select the Item Code
    • Select the Insurer Group
    • Enter the contracted fee
  • The bottom section is where you enter the scaling for the Insurer Group

• Maximise the screen for a better view
• Use Grouping and Filtering to manage
• Click on the first row under the column heading Item Code to select an Item Code. Non-MBS Item Codes (Prosthetics, etc.) need to be added in Utilities - Lookups - General - Items in order to select them here
• Select the Insurer Group
• Only select an Insurer Fund should that individual Fund have a different contract to the Insurer Group
• Enter the Fee
• Select if DRG or Casemix
• Tick Default for this fee to be the default fee on entering the Item Code on the IFC/Invoice.
• If an Item Code can be a 2nd Procedure, enter it twice and do not select Default on the 2nd entry and enter the 2nd Procedure fee. On generating the IFC/Invoice, right-click on the Item and select Contract Fee - 2nd Procedure

Pre-Admission and Theatres Non-Billing Entities

• If you have only one theatre and do not require to book patients into a separate Pre-Admission Entity, then no need to add Non-Billing Entities. Otherwise,
• Add a new Entity and select This Entity is a Company and enter a name
  • ...Pre-Admissions
  • 1 Theatre One
  • 2 Theatre Two
  • 3 Theatre Three
• Select Category Day Surgery or Hospital
• Enter the Hospital Provider number

• Select Is a Non Billing Entity on the About tab, resulting in the Billing Entities being listed
• Select the Hospital Billing Entity

• Save and Close

Overview

DC is a Hybrid Solution unlike a Software As A Service (SAAS). As such, you have your own dedicated secure SQL database that is accessed via the desktop app. For browser access we use Internet Information Services (IIS). The Provider and Client Portals are not an app. They are just a browser interface that reads/writes to the DC database.

Setup

• The IIS service needs to be enabled and the Portals to be published
• It is recommended for security to have a separate IIS server
• Standard Procedures should be setup for the Referrer/Surgeons, see article in Setup DCM - Standard Procedures for further information

Workflow

1. Book a future Admission
   • It is mandatory to select the Referrer/Surgeon at this time
   • Select a Standard Procedure. Optional but recommended, as this will populate necessary detail in the pre-Admission
   • You are prompted to Create the Admission at this time. Again, optional but recommended, as this will populate necessary data in the pre-Admission
2. Send a link to the Client/Patient
   • Right-click on the appointment in either List or Calendar View and select Client Portal URL that is activated automatically. You can deactivate this at any point in time by Deactivate
   • This URL can then be either sent via SMS or Email. Suggest you include instructions in the SMS or Email
3. On the Client/Patient receiving the URL, they select it and log on with the DOB
   • Security is assured with your already having on hand the Mobile Phone and/or Email address
   • Client ID is encrypted and linked to the DOB
4. This takes them to their To Do list with the prompt to Complete pre-Admission

     5. Client selects Complete pre-Admission where detail is prepopulated from the DC database

     6. They then work through each page adding and updating detail

• pre-Admission
• Discharge Summary
• Health Summary
• Compliance

     7. If all completed correctly, the Submit button is active at the bottom of the Compliance page to select resulting in a PDF being created that is saved automatically to Client Communications in DCM and option for the Client to download