Claim Details tabs and fields

Family Name

As per the Medicare Card. Maximum of 40 characters.

First name

Where a patient has only one name, that name should appear in the Family Name field and the word "Onlyname" be entered in the First Name field. Maximum of 40 characters long.

Date of birth

Patient's date of birth.

Gender

Patient's gender.

Medicare Number

Patient's Medicare Card Number.

Medicare Ref No

Patient's Medicare Reference Number. This number appears to the left of the patient's name on their Medicare card. It is one (1) character and can not be a zero (0).

Address

Patient's residential address.

Alias First Name

Patient's First Name as known to the Provider for DVA if different to that known by Medicare. Maximum of 40 characters long.

Alias Family Name

Patient's Family Name as known to the Provider for DVA if different to that known by Medicare (or DVA). Maximum of 40 characters long.

Lodge Claim

To enable the Lodge Claim button, type 'CONFIRM' into the text field. This acknowledges that this claim has been purposely put through.

Item Number

Medicare or DVA item being claimed.

Item Date

Date the service was rendered to the patient or the patient was assessed.

Item Time

Time the service(s) was rendered.

Service Text

Provides additional information to assist with the benefit assessment of the service:

• DVA - Must have no more than 100 characters.
• VAA Medicare BulkBill - Must have no more than 500 characters.

Charge Amount

Amount charged for the service in cents:

• For Bulk Bill and DVA claims, this is the benefit assigned.
• Notional charge amounts are not acceptable for DVA medical pathology claims.

Patient Contribution Amount

Amount paid by a patient to a provider for a service. It can be any amount paid by the patient where the service charge has not been fully paid.

SCP ID

The Licensed Collection Centre Identifier, now known as Specimen Collection Point (SCPId), is used to identify the site where the pathology specimen was collected.

Restrictive Override

Allows payment for a service where the account provides indication that the service is not restrictive with another service either within the same claim or on the patient history.

Options: SP: Separate Sites; NR: Not Related ( Care Plans ); NC: Not for Comparison.

After Care Override

Indicates if service is part of normal after care for the patient.

Duplicate Service Override

Indicates if the practitioner attended a patient on more than one occasion on the same day. Each record MUST have the Time and the Duplicate Service Override checkbox ticked.

Cannot be selected for DVA Claims.

Multiple Procedure Override

Indicates whether service part of a multiple procedure or not. Note: when set, the associated claim is automatically set to pending.

Distance

Travelling distance involved in a Home, Nursing Home or Hospital visit.

If kilometres are claimed for a DVA claim, enter the total distance travelled here against the record with the Item Number = ‘KM’.

Duration

Captures the appointment length in minutes. Required for ALL DVA Speech Pathology claims (e.g. SH01) and MUST be entered manually or the claim will be rejected.

Equipment ID

The identification number of equipment used for the service provided (allocated by the Dept. of Health and Ageing).

Field Quantity

The number of fields irradiated or the quantity of time blocks for derived fee intrathecal or epidural infusion services (e.g. items 18219 and 18227) 2 characters max.

LSP

Location Specific Practice Number. Only used in association with:

• services listed in the Diagnostic Imaging Services Table (DIST) Group T2 - Radiation Oncology
• services in the General Medical Services Table - (GMST)

Where these services occur, LSP is mandatory.

Number of Patients

The number of patients seen. Must be set for group attendance items (eg. counselling) or visits (home, hospital or institution) to ensure the correct payment is made.

Optical Script

Identifies the restriction override for optical claims.

Self Deemed Code

A Self Deemed service is a service provided by a consultant physician or specialist as an additional service to a valid request. A substituted service is a service provided that has replaced the original service requested.

Options are: SD: Self Deemed; SS: Substituted Service; N: Not Self Deemed.

Second Device Indicator

This field identifies the provision of a second medical grade footwear service.

Accession Date Time

A timestamp value as to when the pathology test was actually performed. Note: This is different to any DateOfService and TimeOfService.

Collection Date Time

Date time the actual pathology sample was taken extracted from the patient whether this be blood, tissue or a spontaneous ejection.

Dental

Jaw identifies if the dental service relates to the upper or lower jaw. The following rules apply to Dental:

• Options are: 'UPR': Upper Jaw; 'LWR': Lower Jaw
• Validation Rules: Must be one of 'UPR,LWR'. Must only be set when flags.serviceType is "G".
• Number of Teeth Max 2 characters.  Only applicable when Service Type is "G".
• Tooth  Identifies the tooth number that relates to the dental service provided.

The DVA Dental items that may require a Tooth number to be present for claims processing purposes are as follows: D311, D314, D322, D323, D324, D597, S311, S314, S322, S323, S324, S597 2 characters max.  Only applicable when Service Type is "G".

The DVA Dental items that may require either a value of 'UPR' or 'LWR' to be present for claims processing purposes are: D744,D743,S744 and S743.

DVA Number

Veteran's File Number as it appears on the Veteran Card. Maximum of 9 characters.

Disability Indicator

Indicates whether the services rendered are for a White Card holder and the service is in accordance with the White Card Condition. The options are:

• Checked - (True) Condition Treated relates to a condition for a White Card holder. If DVA Card Type is 'White' in the Client's record, this flag will automatically be checked in the Claim.
• Unchecked - (False) Condition does not relate to a condition for a White Card holder.

Disability

Free text used to provide details regarding the condition being treated. Maximum of 100 characters long.

There are several checks that occur when processing DVA Card Claims. See DVA Card Holder checks for more information.

Cognitive Behavioral Indicator

Indicates if the veteran requires Cognitive Behavioral assistance for the activities of daily living.

Eating Indicator

Indicates if the veteran requires assistance for Eating activities of daily living.

Personal Hygiene Indicator

Indicates if the veteran requires assistance for Personal Hygiene activities of daily living.

Toileting Continence Indicator

Indicates if the veteran requires assistance for Toileting activities of daily living.

Transfer Mobility Indicator

Indicates if the veteran requires assistance for Transfer Mobility activities of daily living.

Tool

The ADL Tool Used Indicator is used for recording the level of activities of daily living functional assessment measure.

Claimant is not the patient

Tick to enable Claimant details to be entered. If there is no claimant saved against the client, Claimant will default to a New Claimant with blank fields.

If there is a saved Claimant, the first Claimant in the list will default into the fields.

Claimants can be added directly to and deleted from the client via the Client Details screen. Details on how are located here.

First Name

Claimant's first name when the patient and claimant are not one and the same. Required if claimant is not the patient. 40 characters limit.

Family Name

Claimant's family name when the patient and the claimant are not one and the same. Required if claimant is not the patient. 40 characters limit.

Date of Birth

Claimant's Date of Birth, where a claimant is specified.

Medicare Number

Claimant's Medicare Card number when the patient and claimant are not one and the same.

Medicare Reference No.

Claimant's individual Reference Number (found to the left of the claimants name on their Medicare card), when the patient and claimant are not one and the same. It is one (1) character and can not be a zero (0).

Claimant Address Line 1

First line of the temporary address to be used for the claim. Cannot be a PO Box. Claimant address details must only be transmitted at the request of the claimant. These address details are temporary and must be used for that claim only. 40 characters limit.

Claimant Address Line 2

Second line of the temporary address to be used for the claim. 40 characters limit.

Claimant Address Locality

The locality of the temporary address to be used for the claim.

Bank Account Name

Used for EFT payments. The claimants bank or financial institution account name.

TIP  The Claimant's bank account details are not saved. It is our recommendation that the Claimant register their bank account details with Medicare rather than rely on payment to the account specified via this method.

Bank Account Number

Used for EFT payments. The claimants bank or financial institution account number.

Bank Account BSB

Used for EFT Payments. The BSB code for the bank and branch where the account is held.

Service Type

Indicates the type of service that makes up the claim. All Item Numbers within the claim must be consistent with the Service Type selected.

For Bulk Bill and Patient Claims, including Allied claims

P: Pathology services

S: Specialist. For Allied claims with a referral this is the claim type usually used. Note, if no referral is required, then see the Override code on the Referral Details tab.

O: General. If this is used, then these claims are manually managed at Medicare, so this option is not recommended.

For Allied DVA

F: Community Nursing

G: Dental

L: Optical

I: Speech Pathology

J: Allied

K: Psych

Account Paid

Indicates whether or not an account has been paid in full.

This is required to be ticked for a Patient Claim to be made successfully.

Date of Lodgement

Date of lodgement of the claim.

NOTE  Should be the computer system date when the claim was created.

Time of Lodgement

Time of lodgement for the claim.

Certified Indicator

Indicates the provider has certified the services within the claim have been provided. Must be Y to submit the claim. This field is rarely relevant for Allied Health.

Hospital Indicator

Indicates if service rendered in hospital or not. If not set, it is assumed the service was not rendered in hospital. This field is rarely relevant for Allied Health.

Admission Date

Date the patient was admitted to hospital or nursing service.

Discharge Date

Date the patient was discharged from hospital.

Location Name

Name of the treatment location (Hospital, Nursing home etc).

For DVA, VAA, Medicare, BulkBill: Required when location type is 'H'.

Location Type

Code specifying where the treatment service was provided:

• V: Home Visit
• H: Hospital
• R: Rooms - this is set by default against all Locations in Practice Information > Location
• N: Residential Care facility
• C: Community Health Centres.

Must not be set when Service Type is "P" - Pathology Services.

Servicing Provider

Provider number of the medical practitioner rendering the service(s) as allocated by Medicare.

Payee Provider Number

Provider number of the principal provider, where the payment is directed to other than the servicing provider.:

• Bulk Bill - Must not equal provider servicing.
• DVA, VAA - Required.

Referring Provider Number

Referring provider number allocated by Medicare.

Referral Date

Date the referral was issued.

Provider Type

Indicates if the referrer is GP or Specialist. This is defaulted to GP.

Override Code

Indicates why referral services were provided without referral from another practitioner.

Used in some instances where a Referral is not required.

Period Type

Period of referral:

S: Standard (12 months from a GP and 3 months from a Specialist)

N: Non-standard

I: Indefinite

Period

Length of the referral in months. (No more than 2 characters).

Requesting Provider Number

Requesting Provider Number - Is the provider number for the requesting provider (allocated by the Medicare).

DVA Required when Flags > ServiceType is "P" - Pathology.

Requesting Provider Type

Indicates if the requesting provider is GP or Specialist.

Request Type

Type of request:

• P: Pathology
• D: Diagnostic Imaging.

Request Date

Date the request was issued.

Request Override Code

Indicates why requested services were provided without a request from another practitioner. Must be one of 'L,E,H,N,G,R,V'.