Claim Details tabs and fields
This article describes the fields in all tabs of the Claim Details - Medicare screen. Most of the default settings do not need to be changed for a normal claim. Not all fields are required for Allied claims, or apply to all Allied modalities.
Patient
Field |
Description |
---|---|
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. |
Items
Field |
Description |
---|---|
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:
|
Charge Amount |
Amount charged for the service in cents:
|
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:
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:
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
Field |
Description |
---|---|
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:
|
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. |
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. |
DVA Card Holder checks
Is this a DVA White Card holder?
If DVA Card Type = blank, then the following message displays to prompt the user to enter White card details if required. The Disability Indicator and Disability fields can be entered into the claim but should be entered into the Client record for display on future claims.
Missing DVA Disability value
If the DVA Card Type = White, then this automatically checks the Disability Indicator checkbox.
If the DVA Disability = blank, then the following message will display. The value can be entered into the claim but should be entered into the Client record for display on future claims.
Missing DVA Disability Indicator value
If the DVA Card Type = White, then this automatically checks the Disability Indicator checkbox.
If this is unchecked, then the following message is displayed. The value can be entered into the claim but should be entered into the Client record for display on future claims.
Gold Card Holder check
If the DVA Card Type = Gold and the Disability Indicator is checked on the DVA tab in the claim, then this message will display as the Disability Indicator and Disability field should not be filled in for a Gold card claim. However, if this is correct then it allows the claim to be processed and the DVA Card Type should be updated in the Client record.
Claimant
First Name, Family Name, Date of Birth, Medicare Number, and Medicare Reference No. are mandatory to process a patient claim for a child.
Field |
Description |
---|---|
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. |
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. Details on how to manage Claimants can be found here as they can be added against the client details, or added on the fly here.
Flags
Field |
Description |
---|---|
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 claimsP: 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 DVAF: 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
Field |
Description |
---|---|
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:
Must not be set when Service Type is "P" - Pathology Services. |
Provider
Field |
Description |
---|---|
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.:
|
Referral
Field |
Description |
---|---|
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). |
Request
Field |
Description |
---|---|
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:
|
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'. |