Online Claiming: Direct Bill

Enable online claiming for batched direct billed accounts through the Bp Premier Configuration screen.

1. Log in to the Bp Premier server as a user with administrator permissions.
2. Select Setup > Configuration from the main screen. Select the Online claiming tab.



3. From the list of check boxes at the top of the screen, tick the options that apply:

Activate Online Bulk Bill Claiming	Always tick this option to activate direct bill online claiming.
Activate Tyro Integrated EFTPOS	Tick this option only if your practice uses a Tyro terminal to process patient claims and processes direct bill claims through the terminal by EasyClaim.
Activate EasyClaim Bulk Bill claiming	Tick this option only if your practice uses a Tyro terminal to process patient claims and processes direct bill claims through the terminal by EasyClaim.

For instructions on how to process direct bill Easyclaims, see Online Claiming: EasyClaim and Tyro.

4. Optional settings that can be enabled in Online Claiming:



A5 Vouchers	If ticked, Medicare DB4 vouchers will be printed in A5 size.
Print 2 copies of Vouchers	If ticked, two copies of the Medicare DB4 voucher will be printed. To print just one copy, uncheck the box.
Maximum No. of vouchers in a batch	80 is the maximum number of vouchers that can be sent to Medicare in a single batch. If preferred, this can be set to a lower number.
Default number of months to display when viewing all batches	Specifies how many months are displayed in the Online Claiming screen when viewing all batches. By default, this has been set to 12 months.

When a doctor or provider finalises a visit or practice staff are processing an account, indicate direct billing by:

• From the Patient record, click Finalise visit and select 'Direct bill' in the Account type drop-down list.
• From the Account details screen, set the Bill to field to 'Medicare Direct Bill' or 'DVA Direct Bill'.

Use the Store button, which makes the account immediately available to include in the next direct bill batch. Clicking Held will hold the account, and it will not be eligible for inclusion in a batch until stored.

Click Print if you wish to print the Bulk Bill Assignment of Benefit form and make the account immediately available to include in the next direct bill batch.

Change a provider's default account type to Direct Bill

You can change a provider's default account type to direct bill from Setup > Users > Edit > Default account type.

How often a practice should send direct bill batches will depend on the size and billing preferences of the practice. However, batches should be sent to Medicare at least once per day; busier practices may wish to send multiple batches in a day at regular times.

Direct bill batches are managed from the Online claiming screen. Select Management > Online claiming from the main screen. All of the following procedures start from the Online claiming screen.

1. Click the icon or select File > New claim menu item to open the Direct bill batch screen. The screen will be empty to start.



2. Select the Location and Provider to create a batch for. Only services performed at that location by that provider will be included in the batch. Limiting batches by provider and location can make batches more manageable and assist with reconciliation.
3. Select the type of batch to be created: Medicare or DVA.
4. Select if the batch is for Hospital Services, Imaging Services, or both.

NOTE  Medicare require that hospital in-patient services are batched separately. Use the Hospital services check box to generate hospital in-patient claims.

5. Each hospital services batch must be made up of claims from a single hospital. If you are creating a batch for hospital services, a drop down menu listing all hospitals with vouchers to be processed will appear. Select the hospital you wish to create the batch for. DVA does not require this separation and this option will be unavailable when DVA is selected.

The hospital must be added as a contact with a provider number in Bp Premier, or you will receive an error when sending the batch. See Invoice and store for batching for more information.

6. Click Create batch. Bp Premier will generate a batch containing a maximum of 80 'vouchers' for the selected doctor that have not been previously sent to Medicare.



7. Untick any vouchers that you do not want to include in the current batch. Unticked vouchers will be eligible for inclusion in subsequent batches.
8. Click Send batch to transmit the batch to Medicare.

If transmission is successful, a voucher is marked as ‘Sent’ and excluded from future batches.

NOTE  If there are any vouchers that cannot be sent (for example, because the demographic information is incomplete), a message will be displayed and the vouchers will not be included in the batch. 

9. To print a statement of the batch that has just been transmitted, click Print statement.
10. Repeat steps 2–9 to send vouchers for other providers. If you do not want to send any more batches, click Close.

Approximately the next business day after lodgement, the claims should be processed and the payment reports available from a Check for Payments.

As with sending batches, how often a practice should check for payments from Medicare will depend on the size and billing preferences of the practice. But at least once per day, staff should check for payments, so that new batch payments are updated within the system and any unpaid claims can be reviewed and actioned.

1. Click Check for payments from the Online Claiming screen. Bp Premier will connect to Medicare. This process may take a few minutes depending on how many unpaid batches are currently in the system.

In Saffron SP3, depending on the claim's status with Services Australia, the following alerts may appear:

Alert	Description
REPORT_NOT_FOUND	The claim information does not match Services Australia's records. Contact Services Australia for more information
REPORT_NOT_READY	The claim has not yet been finalised by Services Australia. Try again later.
REPORT_NOT_AVAILABLE	The claim was processed and has been rejected. Check the processing report for more information.

Once all the payment information has been identified, the Online claim payments summary screen will appear showing returned payments and exceptions.

If you are unable to perform the check for payments, contact Medicare to ensure that the batch has been received.



Online claim payments includes the following sections:

Payments received	Lists all payment runs since the last check for payments. Select a payment run to view the claims included in that run.
Claims included in payment	Shows the claims within the selected payment run, and Claimed against Paid amounts.
Claims containing exceptions	Lists all claims in the selected payment run that contain exceptions or errors; that is, the amount paid for a claim is different to the amount claimed. Select a claim to view the services with exceptions in that claim.
Services with an exception on the highlighted claim	Shows the services that have an exception in the selected claim, and the Medicare Explanation for the exception.

NOTE  As of Saffron SP3, claim numbers will reset to A0001 every day for each provider. To search for a particular batch, use the claim number in combination with the batch date.

2. Tick Print items without explanation codes on processing reports if you want to show all services claimed on the report regardless of whether they had an error. Normally these are not shown.
3. Click Save to save all payment and processing reports for the payment runs shown, update all batches and create any related payment records.

Depending on the number of batches included in this check for payments, this process may take a number of minutes. A message will appear on screen to indicate that the update is in process.

When you return to the Online Claiming screen, Bp Premier will update the status of batches and services from the payment runs you just saved:

Status type	Bp Premier status after saving
Batch Status	Unpaid – Batch was transmitted to Medicare / DVA but has not yet been processed. The batch will be included in a future check for payments. If the batch remains unpaid for more than a few days, contact Medicare to ensure that they received the batch transmission.
	Reconciled - Batch has been paid in full, or any errors have been rectified and resubmitted in another batch. The total amount claimed equals the total paid plus adjustment columns. Reconciled batches are removed from the default list of batches displayed in the Online claiming screen. To show the reconciled batches, tick Include reconciled batches, enter the Start date and End date, then press the Apply filters button. You can also filter on specific Doctors, Locations or Batch type
	Received – Batch may be unpaid or partly part but contains errors that have not been actioned.
Service Status	Sent – Service was transmitted to Medicare but has not been processed.
	Not Paid – Service has been processed by Medicare but an error has occurred. The error is shown in the Note column and on the processing report. The service must be corrected before the batch is reconciled.
	Paid – Service has been paid in full.
	Resent - Service was rejected in this batch and has been actioned to be resent in another batch.
	Refunded - Service had been paid or partly paid but has been refunded. Comment field will show any user enter details on why this was done.

4. If some batches still have a status of 'Received', you will need to reconcile those batches.

Once the check for payments has been completed, claims that have a difference between the amount claimed and the amount paid will have the status Received. You can reconcile batches with a received status from the Online Claim batch screen.

1. Double-click on the claim you want to reconcile in the Online claiming screen. The Online Claim batch screen will open, showing all the exceptions in a claim, with the Explanation given by Medicare for the difference in payment.

You have three options to reconcile unpaid services from this screen:

Patient details

Fields in error in a patient's demographic, like an invalid or missing Medicare number, can cause a claim to be rejected. The Explanation field will provide more information on missing or invalid details.

1. Select the service and click Patient details.
2. Make changes to the patient's Medicare details and click the Medicare/DVA eligibility check button to validate the new settings.
3. Click Save to return to the Online Claim batch screen. The Action column will change to ‘Resend’.
4. Follow the instructions in the next panel Finalise Reconciliation.

Adjust service

1. To correct issues other than patient demographics, select the service in error and click Adjust service. The Adjust billing screen will appear.



2. Select one of the following radio buttons, depending on the error to reconcile:

Field	Description	Action
Mark as fully paid	Do not use this option. No payment record will be created if this option is selected.	Fully Paid
Resend service	Select only if Medicare has had an issue on their end and they have requested that you resend the item with no changes. The service will be included in the next batch created.	Resend
Change Item number	Select if Medicare have rejected the original item number claimed for, and the provider wishes to substitute a different item number for the service. Click Change, select the new item number, enter any applicable Service text and click OK.	Change Item
Edit Voucher details	Select if you want to add additional details to the invoice, such as No of patients, Notes, or Not normal aftercare. Click Save to update the details.	Resend
Edit Service Text	Select if you want to change or add service text for an item, for example, if two of the same items have been claimed, and one item needs service text to clarify and resend.	Resend
Accept fee of	Select if the item has been underpaid by Medicare because of Medicare rules, and you accept this payment.	Accept
Change billing	Select if this service will not be paid by Medicare or DVA and you wish to change the billing type to another method, or you need to change a bulk bill from DVA to Medicare. If the billing is changed to private, the service will be removed from the current batch.	Change Payer
Write off	Select to write off this service. Writing off removes the service from the batch.	Write Off

3. Follow the instructions in the next panel Finalise Reconciliation.

1. Select Management > Online claiming from the menu or press Ctrl+F9. The Online claiming screen will appear.
2. Select the batch containing the service you need to refund. Right-click the service in the bottom half of the screen and select Refund/Adjust Payment. The Refund/Adjust Payment screen will appear.



3. Select 'Refund entire payment to Medicare' from Select the type of adjustment.
4. Select the Refund method by which your practice will refund the amount to Medicare: Direct Credit or Cheque.
5. Enter any applicable Comments to explain why the refund is being made. The comments will show on the Online Claiming screen.
6. Click OK to process the refund.

What do I do next?

Pay the refund amount back to Medicare by the method your practice normally uses (and indicated in step 4).

The service will be updated as 'Written off' in the billing history and adjustments will be created to reverse the payment and show the payment being refunded to Medicare. You do not need to manually adjust any payments to doctors. The refund to Medicare will be deducted automatically in all payments, services, and transactions reports.

If the service is being refunded because of an error such as a wrong item number, create a new account to process the refunded service correctly.

This section provides some suggestions for troubleshooting issues with your connection to Medicare Web Services (MWS) and PRODA. If a submission has been declined, consult this list before calling Best Practice Software Support to see if you can resolve the problem.

NOTE  NOTE Medicare certificates no longer need to be configured. The functionality provided by Medicare certificates has been replaced by Medicare Web Services.

Bp Premier offers a 'legacy' option to manually create batches of claims for mailing to Medicare, and reconcile processed batches. Online patient claiming removes the need to manually create and mail batches. However, in rare circumstances, such as a long term loss of internet connection, it may be necessary to manually batch and submit claims.

One example of manually creating a batch is to record a payment that Medicare has made manually, which will not be picked up by Bp Premier automatically as part of online patient claiming. See Record a payment made manually by Medicare for more information.

A report is printed when a batch is created this way. The report is intended to be mailed to Medicare for processing and payment.

NOTE  Do not modify the default batch number unless directed by Bp Premier Support. If an existing batch number is reused, Bp Premier will create duplicate batches and may cause issues running a check for payments.

1. Select Management > Manual direct bill batches from the main screen of Best Practice. The Direct bill batches screen will be displayed.



The top section shows any batches that have been entered but not reconciled. By default, the last batch entered is selected and the services that make up the batch are shown in the bottom section.

2. Click the icon or select File New batch. The Direct bill batch screen will be displayed.
3. Select the Provider from the drop down list. Any Medicare, Hospital, and DVA vouchers for the selected provider that have not yet been batched will be displayed.
4. Click either Medicare or DVA at the top to display the list of items to be batched of that type.
5. Tick the Hospital services check box to also include Hospital services vouchers.
6. Click Create batch and the list of services that have not yet been batched will be generated. The check box adjacent to each service will be ticked. The batch number automatically increments each time a new batch is created.
7. Check the list. For any services you do not wish to include in the batch, untick the service. The Total of batch at the bottom of the screen will adjust.
8. When you have selected all the services to be included in this batch, click Print & Save to print and save the batch.

Depending on the services chosen, either the report Claim for Assigned Benefits for Services rendered to Non-hospital Patients or the report DVA Claim for Treatment Services will be printed. The new batch will be displayed in the Direct Bill batches screen.

Delete a manual batch

You can delete a manually created batch until the batch has been fully reconciled.

1. From the Direct bill batch screen, select the batch you wish to delete and select File > Delete Batch.
2. You will be prompted to confirm you want to delete the batch. Click Yes. The batch will be removed from the list.

After a batch has been deleted, the vouchers and services which made up the batch can be selected again to create a new batch.

Reconcile a Manual Batch

1. From the Direct bill batch screen, select the batch to reconcile and click the icon or select File > Reconcile batch. The Reconcile Direct Bill batch screen will appear.



2. Type in the amount received in the Amount paid field.
3. Set the Date paid to the appropriate date, and indicate the payment method (for example, tick Direct credit if the payment was paid directly into the practice’s bank account).
4. Confirm that the Amount paid equals the Total of selected services and click Save. You will return to the Direct bill batches screen and the Amount owing will be adjusted to reflect the amount paid.

If Medicare have contacted you and specified an exception in the batch, click Adjust Service from the Reconcile Direct Bill batch screen to address the exception and resend in a new batch.

If you click Cancel from the Reconcile Direct Bill batch screen, any changes made such as written off items or adjusted services will not take effect.