Request Claim and Request Quote Screen

Request Quote / Request Claim Screen

 
The Request Quote and Request Claim screens are essentially the same except for the buttons used to send through the claim information. This page links the details seen on this screen back to the details on the Setup page.
 
The RED section below includes:
Invoice ID / Quote ID – Identifying number of the Quote or Invoice. Assigned by the system.
Invoice Date / Quote Date – Date of the Quote or Invoice. This will default to “Today’s” date unless changed.
Provider Name – Name of the practitioner providing the service. This will default from the Invoice or Quote. There can only be one provider per claim.
Provider Number – Provider Number linked to the Practitioner for the relevant Health Fund and is added in Options > User Administration > Provider Numbers.
Health Fund – The health fund that the claim has been made against.
Service Type – Modality of the Provider. There can only be one Modality per claim. This is linked from the Product or Service selected and is updated in Data Maintenance > Products and Services.
HF Family Number – Family member identifying digits from their Health Fund Card. This can be saved against the client record.
 
 
The GREEN Section above displays the Quote or Invoice items to be claimed for:
Appt Date – Either the date of the appointment, or if a Quote, then it is “Today’s date”. It can’t be a future date. If an item does not have an appointment associated with it,  the Appt Date for that item will be set to be the same as the item with an appointment date when the claim is sent.
Item Code – Appropriate Health Fund item code that can be claimed for. These codes should be obtained from the various Health Funds registered with.
Item Description – Description of the service provided
Body Part / Tooth Number – Related body part or tooth number if relevant. Maximum 3 digits.
Service Type – Modality of the service provided
Claim Amount – Cost of the service provided
Rebate Amount – Amount the Health Fund will pay. This field is only filled in once Request Quote or Lodge Claim has been lodged
Item Status – Whether the item has been approved or not. A status of 0000 = Approved. Approval of an Item does not mean that the Claim has been approved. See Tyro's Response codes for private health claims for more information.
 
 

Lodge Claim

 
When a claim is lodged using the Lodge Claim button with a Health Fund, the following information is returned in addition to the Rebate Amount and Item Status that is saved on a per item basis.
 
The GREEN section below includes:
Total Claim Amount – total dollar amount for the entire claim
Total Rebate Amount – total dollar amount to be paid by the health fund including any Loyalty amount. The specific loyalty payment can be viewed on the Invoice screen.
Total Gap Amount – total amount to be paid by the client
Count of Items – number of items submitted in the claim
 
 
The RED section above includes:
Claim Status – overall status of the claim. This reflects whether the client Accepted (Approved) or Rejected (Voided) the claim.
 
Claim Statuses
  • APPROVED – Claim was Approved by the Health Fund and Accepted by patient
  • VOIDED – Claim was Approved by Fund and Rejected by patient
  • CANCELLED – Claim is already cancelled
  • RECONCILED – Claim is already settled (Claimed prior to this day)
  • DECLINED – Claim was declined by the Health Fund
  • FAILED – an error occurred during processing of the Claim, system Void
 

Request Quote

 
When a quote is requested via the Request Quote button, the same information is received as when a Claim is lodged however there is no overall Claim Status as the claim is Rejected by the Client. The only approval viewed is per item.