Managing Medicare Claims

The purpose of this guide is to give details on the process of managing the different types of claims in Bp Allied. This is applicable to any customer who is using Medicare Online Claiming within Bp Allied
On this page:
DVA & Bulk Bill
Patient Claims

Bulk Bill & DVA

Creating Claims
Bulk Bill and DVA Claims are created when an Invoice payment is made. Information on creating these claims can be found here and here.
Resubmitting Claims
Bulk Bill and DVA Claims are resubmitted by clicking the Resubmit button in the Failed tab.
Use the Assessment Code and Assessment Code Note along with the information from Medicare and DVA to ascertain why a claim has been rejected. Details of the rejection codes can be found for Medicare here for common rejection codes and here for details on all reason codes. DVA rejection code information can be found here.
Full details on using the resubmission process can be found here.

Patient Claims

Creating Claims
Patient claims are managed differently to Bulk Bill & DVA claims because full payment from the Client is received at the time of the claim and the Medicare rebate from these claims is not received by the practice. Information such as if the claim has been paid by Medicare is not available for us to feed back into Bp Allied, hence a Patient Claim will never get a Claim Status of Processed or Complete. All Patient claims sit in the Pending tab (this is new in V6 SP3).
Information on creating a patient claim can be found here. Note: Patient Claims have a Claim Type = Medicare.
Resubmitting Claims
These claims cannot be resubmitted in the same manner as Bulk Bill or DVA claims. Limited information comes back via the Medicare API on the status of these claims and often if will be a client that will report an issue but the status will not indicate this.
To be able to resubmit a claim that has stalled there is a special function on the Pending this tab that allows a patient claim to be Manually Declined based on the information received from your client. This over rides the resubmit function not available to a Patient Claim. From here the claim moves to the Failed tab and then resubmitted in the usual manner.
Occasionally, a status of With Medicare, Delayed or Lost can be returned if there is a problem with details submitted with the claim. These patient claims can also be viewed on the Pending tab to be able to make use of the Manual Decline function.
Full details on using the manual decline process can be found here.