Create a Client Invoice with Medicare Patient Claim

Before you start

The following information needs to be in Bp Allied for the client/claim before a claim on behalf of the patient can be made:

  • Client first and last names
  • Clients date of birth
  • Client’s Medicare card and reference number - this can be validated in the Client record
  • A valid referral, including the Referrer's name and provider number must be attached to the appointment being claimed.
  • The exception to this is the ability to send Medicare claims without a referral for any Bushfire identified MBS Item codes
  • An appointment for a location that has a relevant Location Type and provider number for the practitioner supplying the service
  • Relevant Medicare Item Code attached to the appointment
  • The client must pay the account in full prior to the claim being made
  • The client’s bank account must be registered with Medicare.

Claims for Children and Minors

Children and Minors who do not have their own Medicare card with the bank account registered against it MUST have the Claimant details filled in for the claim to be paid. The claimant must have their bank details registered with Medicare.

Click here to set up Bp Allied for Medicare Online Claiming.

NOTE  A Patient Claim, Bulk Bill or DVA Claim can ONLY be processed against a Client Invoice. They can not be processed against a Third Party Invoice.

Create an Invoice with a payment and process a Medicare Patient Claim

  1. From the Appointment Book, right click on the client appointment to be invoiced.
  2. Select Create Invoice.
  3. Rght-click the appointment and select Create Invoice

  4. Select Client as the Invoice Type to generate an invoice to bill a client directly.
  5. See more information regarding 3rd Party Invoices here.
  6. Click OK.
  7. If a Draft Invoice found for the current client, then the following dialogue will display.
  8. Click Yes if the draft invoice applies to the appointment and needs to be completed, or No if you need to create a new invoice.
  9. Bp Allied can process 2 or more services for the same patient on the one Invoice for a Patient Claim.

    When processing multiple services, they must all be on different days, or the Provider must check the Duplicate Service Override checkbox in the Item/s tab of the Claim Details when submitting the claim and ensure the Times are set and are different for each Service.

  10. The Payment Processing dialogue box will display.
  11. Click Yes to accept payment. The service must be paid for Prior to a Patient Claim being made.
  12. If not accepting payment now, Click here for how to add a payment at a later date.

  13. The Payment Details screen will display.
  14. Select a Payment Method and click OK

  15. Enter in the Payment Method.
  16. Enter in the payment amount if different to the total amount. Click here to see how to add a additional payment.
  17. The Invoicing tab will show the new invoice, with the details on the right hand side.
  18. Patient Invoice is displayed after payment is made

  19. Click Process Patient Claim. The Process Patient Claim box will display.
  20. Click OK to create the claim

  21. Click OK. The Claim Details screen appears.
  22. Check the claim details, type CONFIRM in capitals and click Lodge Claim

  23. Check the claim details. Type CONFIRM and click Lodge Claim.
  24. The next steps depend on whether Medicare and DVA validation detects issues with the claim details:

The following alert will appear if issues are detected:

Medicare or DVA validation has raised issues with the claim details. The user has the option to correct, send anyway, or cancel.

NOTE  The option selected here is visible in the Patient Claim Option Selected column of the Medicare Claims History Report.

No issues are detected

The Medicare Online Claiming Result will show an outcome of 'MEDICARE_ASSESSED'.

    Claim status is set to ASSESSED to be paid by Medicare or DVA

Click OK.

The Invoicing screen shows the Claim Status number.

Claim field updated with claim number

Clicking on the Claim Status will show the status of the claim.

Click the claim number to view the claim status

Click OK to close the information box.

The Latest Claim Status in the bottom right of the Invoice details will also show the most recent status of the claim.

Latest Claim Status for item in invoice

Correct the claim and resend

  1. Click Edit and re-send. The claim status is set to PENDABLE while the claim is being edited.
  2. Bp Allied will return to the invoice for the claim to edit

  3. Click the Re-send patient claim link to open the Claim Details screen for editing.
  4. Resend the claim to open the claim details and correct the issues raised by validation

  5. Edit the claim details to correct the reported issue, type CONFRIM, and click Lodge Claim. In the example above, an after care override flag has been added to the claim .
  6. The claim will be resent to Medicare or DVA and the status updated to PENDED.
  7. Claim status will be set to PENDED on resubmission

  8. Medicare or DVA will assess the claim as normal.

Submit without alteration

  1. Click Re-send Now. The claim status is set directly to PENDED.
  2. Resend will set the claim to a status of PENDED

  3. Click OK. The Latest Claim Status in the invoice details will show the Pended status.
  4. Invoice Details will show a status of PENDED while the claim is assessed

  5. Medicare or DVA will assess the claim as normal.

Cancel the claim

  1. Click Cancel. The claim will be set to manually declined.
  2. The claim status will be set to Manually Declined. Click the Process Patient Claim link to resend the claim at a later date

  3. Click the Process Patient Claim link to resend the claim at a later date.

Print the invoice

An Invoice can be printed, previewed via the Print button options or emailed from here.

For auditing purposes, the selection made by the user for claims that require correction (Edit and Re-send, Re-send Now, or Cancel is displayed in the Medicare Claims History Report.

Patient Claim Option shown in Medicare Claims History Report

 

Last Modified: 15 March 2022