Set up Medicare Online Claiming (MOC)

By setting up your Clients, Referrals and Products and Services as indicated below, the correct information will be automatically sent with your claim. You should not need to change any claim information.

The known exceptions are:

Initial setup

To set up Medicare Online Claiming (including DVA and VAA):

  1. Bp Allied Sales team issue a Medicare Online Claiming License. This license contains the Minor ID and AuthGroup name and ID for the practice.
  2. Install the licence via System > Options > Certificates > Medicare Online Claiming.
  3. Each Practitioner to have their Provider Numbers associated to the relevant Auth Group via System > Options > User Administration > Provider Numbers
  4. Import the MBS Medicare Scheduled Benefits File in Data Maintenance > MBS (Scheduled Fees).
  5. Update Products and Services with MBS benefits, via the MBS Scheduled fees > Update Products and Services for all items with the relevant Item Code.
  6. If relevant, import the DVA Scheduled Benefits File in Data Maintenance > DVA (Schedule Fees).
  7. Update Products and Services with DVA benefits, via the DVA Schedule fees > Update Products and Services for all items with the relevant Item Code.
  8. Set up travel, speech pathology, white card holder information and other specific DVA options. See Set up DVA Claiming for further details.
  9. All locations are set up with a Location Type = R by default. If any claiming will relate to other locations, such as Home Visits or Residential Care facilities, a new location needs to be created with the relevant Location Type set. Any appointment that relates to these claims must be set against that Location. Locations are set up in System > Options > Practice Information.

A note about Minor IDs

Bp Allied will issue a new Minor ID for each practice that uses either or both Bulk Bill and Medicare Patient Claiming. Linked to this minor ID will be any practitioner’s provider number that claims will be made for. This means that a practice will be unable to run Medicare Easyclaim and the Bp Allied Medicare integrations at the same time because they will be running under two different Minor ID numbers. A practitioner’s provider ID can only be linked to one Minor ID.

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.

Patient Claiming

Allows the practice to claim back from relevant Medicare rebate on behalf of the patient. The rebates are processed via an overnight batch and usually transferred into a Client’s bank account the following day.

The following information must be recorded in Bp Allied to process the patient claim:

  • Client first and last names
  • Clients date of birth
  • Client’s Medicare card and reference number
  • Valid referral, including Referrers name and provider number
  • An appointment for a location that has a relevant 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. See how to set these up here.

General rules for patient claims

  • The client pays in full prior to the claim being processed on their behalf
  • We can process two or more services for the same patient on one Invoice for a Patient Claim
  • When processing multiple services, services must 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.

Bulk Billing

The following information must be recorded in Bp Allied to process the bulk bill (direct bill) claim:

  • Client first and last names
  • Clients date of birth
  • Client’s Medicare card and reference number
  • Valid referral, including Referrers name and provider number
  • An appointment for a location that has a relevant provider number for the practitioner supplying the service
  • Relevant Medicare Item Code attached to the appointment
  • Amount charged for the service must equal the bulk bill amount

General rules for bulk bill claims

  • No payment is taken from the Client
  • No Gap can be charged. Sell Price for a BB Item in Products and Services must be the same as the MBS Benefit Fee
  • Client must sign a voucher to assign the right for you to claim - The BulkBill.pdf voucher is installed into each computer's User Folder path in a Sub-folder called Medicare, eg C:\Users\Public\Documents\myPractice\Medicare\BulkBill.pdf. This Bulk Bill template will be filled out by Bp Allied and used for printing off a copy for the Patient to sign & keep and the Practice to keep.
  • Non-claimable items cannot be on the same invoice as a Claim if the Claim is Bulk Billed or DVA.
  • Bp Alllied can process two or more services for the same patient on the one Invoice for Bulk Billing.

When processing multiple services, services 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