Medicare Online Claiming - Setup and Processing Rules

Setting up Medicare Online Claiming for the Practice

 
For the initial set-up of Medicare Online Claiming (including DVA / VAA) the following needs to be done:
  • Bp Allied Sales team to issue a Medicare Online Claiming License (From January 2019, this replaces the certificate process). This license contains the Minor ID and AuthGroup name and ID for the practice.
  • This is installed via System > Options > Certificates > Medicare Online Claiming
  • Each Practitioner to have their Provider Number(s) associated to the relevant Auth Group via System > Options > User Administration > Provider Numbers
  • Import the MBS Medicare Scheduled Benefits File in Data Maintenance > MBS (Scheduled Fees)
  • Update Products and Services with MBS Benefits, via the MBS Scheduled fees > Update Products and Services for all items with the relevant Item Code.
  • If relevent, import the DVA Scheduled Benefits File in Data Maintenance > DVA (Schedule Fees)
  • Update Products and Services with DVA Benefits, via the DVA Schedule fees > Update Products and Services for all items with the relevant Item Code.
  • Refer to See details on Setting up DVA Claiming for details about setting up Travel and Loading options
  • All locations are setup with a Location Type = R by default. If any claiming that relates to other locations, such as Home Visits or Residential Care facilities is going to take place then a new location needs to be created for these locations 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.
 
Please 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.
 

Claiming on behalf of the patient

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.
 
Information required to be in Bp Allied to enable the claim to process:
  • Client first and last names - please see rules on the client name formats allowable
  • 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.
 
Rules
The client pays in full prior to the claim being processed on their behalf
Yes we 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
 

Bulk Billing

Allows an individual patient appointment that qualifies for Bulk Billing to be processed as part of creating an invoice for that appointment.
 
  • Client first and last names -please see rules on the client name formats allowable
  • 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
 
Rules
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 computers 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 via the system and used for printing off a copy for the Patient to sign & keep and the Practice to keep.
Non-claimable items can't be on the same invoice as a Claim if it is Bulk Billed or DVA
Yes we can process 2 or more services for the same patient on the one Invoice for Bulk Billing
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
 

DVA / VAA Claiming

See details on Setting up DVA Claiming