Title

Quick Reference Guide

This stepthrough article is for practices that batch and send direct bill (bulk bill) claims through Medicare Online, and describes how to:

1. Activate online claiming for direct bill accounts.
2. Bill an invoice to 'direct bill' and store for batching.
3. Send claim batches to Medicare Online and check for payments.
4. Read the payment and processing reports and reconcile common unpaid scenarios.
5. Adjust a service for reconciliation.
6. Troubleshoot some common errors that may occur during online patient claiming.

The article also describes how to manually create a batch and reconcile a manually created batch, for legacy purposes. Practices that use online claiming should rarely ever need to manually create a batch.

The steps in this article assume that you have set up all of your minor IDs, installed your Medicare certificates, and tested that online patient claiming works for your Bp Premier installation. If you have not set this up already, see the following articles for more information:

• Set up Online Claiming for single Minor ID
• Set up Online Claiming for multiple Minor IDs
• Configuring Medicare Certificates

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.

NOTE  As of Saffron SP3, the Correlation ID column has been added to the Online claiming screen. You may need to provide the correlation ID to Medicare when contacting them about a batch.

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 checkbox to generate hospital in-patient claims.

5. In Saffron SP3, each hospital services batch must be made up of claims from a single hospital. If you are creating a batch for hospital services, a dropdown 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.

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.

Medicare processing and payments reports are available for processed batches.

Download a payment or processing report

If a payment report is not showing for a batch, Bp Premier can check for that report and download the report for you to view and print.

1. Select the batch on the Online Claiming screen and select File > Get payment report or Get processing report. Bp Premier will retrieve the report.
2. After the report is downloaded, select View > Payment reports or Processing reports.

Print payment or processing reports

You can print all reports, or single reports to aid reconciliation or banking.

1. From the Online claiming screen, select View > Payment reports or View > Processing reports from the menu.
2. The Payments reports screen shows one report for each deposit made by Medicare. Select a report in the top half to view the information in the bottom half. Double-click a report to view and print the payment report individually.



3. The Processing reports screen lists each claim that has been processed that had errors. Double-click a report to view and print just that report.



4. By default, the processing report shows only exceptions that have an explanation code. To include exceptions without an explanation code in the report, tick Include items without explanation code.
5. Click Print to print the processing or payment reports displayed.

What are the payment and processing reports? 

Medicare Australia processes claims and makes payments overnight for all claims that have been processed. There are two types of reports returned from Medicare Australia: Payment reports and Processing reports.

Payment reports can include the payments for multiple claims, so there will often only be a single payment report even if several claims have been submitted in the last 24 hours. There will be a payment report for each deposit into the practice’s bank account.

DVA and Medicare reports are separate, so a payment report will never include both DVA and Medicare payments. The payment report includes details of the bank account into which the payment was made, how much was paid and what claims were included in the payment.

Processing reports contain an exception list of all services within a single claim where the amount paid was not the same as the amount claimed, including a code indicating the reason for the difference. There will not be a processing report for a claim that has been paid in full.

What can I do with these reports?

The payment and processing reports provide information on individual claim processing and payments. The Online Claiming screen presents a 'current state' summary of claims in a batch. For reconciliation or banking, you may need to look at the processing or payment details of a single claim.

If you need to identify the source of a deposit from a bank statement, for example, you can use the payment report to match the date and account of a Medicare deposit to the payment on the bank statement.

If you need more information on why a claim was unpaid, you can use the processing report to view details of how the claim was processed by Medicare. The processing report contains information that you may need to supply to Medicare if you dispute the claim decision.

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. As patient details are corrected or items are adjusted, the Action column in the Online Claim batch screen shows the action that Bp Premier will take when the user clicks Process.
2. After all services in a batch have been adjusted or resent, click Process.
3. The batch will automatically be marked as ‘Reconciled’ and removed from the list of Unpaid batches on the Online claiming screen. Tick the Show all batches tick box to view the batch details again.

Bp Premier will take the following actions per service based on the user's reconciliation selections. Unless a service changed the Billed to value, no other user actions are required.

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.

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.



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.

The following information may be useful for troubleshooting technical issues with online claiming. This section also describes how to resolve batches that have remained 'unpaid' after several days, and how to record a Medicare payment made outside of online patient claiming.

This article provides a list of return or error codes returned by Medicare after your practice has submitted online claims, and the cause and resolution actions for each code. If a submission has been declined, consult this list before calling Best Practice Software Support to see if you can resolve the problem.

Some resolutions will require your IT Support or a Windows administrator with knowledge of updating environment variables and setting access permissions on folders.

NOTE  In Saffron SP3 and later, Medicare certificates no longer need to be configured. The functionality provided by Medicare certificates has been replaced by Medicare Web Services.

See Troubleshoot Medicare Web Services and PRODA for troubleshooting advice for Medicare Web Services and PRODA-related error messages.

Common Medicare return codes

General troubleshooting steps

NOTE  In Saffron SP3 and later, Medicare certificates no longer need to be configured. The functionality provided by Medicare certificates has been replaced by Medicare Web Services.

If you receive a generic error message, a code not included in the list above, or the following message, follow the resolution steps below to see if the problem is resolved before you call Best Practice Software Support.

If the practice has not registered correctly with Medicare, an entire batch may remain 'unpaid' indefinitely. Batches may also remain unpaid if an error occurred during sending that was not received by the Bp Premier user. In these cases, Medicare may request that batches be resent.

The most common reason for an unpaid batch is that a Doctor has not yet registered his or her provider number with Medicare at your practice, especially if they are new. See Troubleshooting a whole unpaid batch for more information.

You will need the user permission Resend batches to perform this.

Resend a whole unpaid batch

NOTE  Always check for payments to see the most recent updates before resending a batch. You should only resend a batch if advised by Medicare.

The following limits to resending a batch apply:

• You can only resend batches that have a status of 'unpaid'.
• DVA and Medicare services must be dated within the last two years.

To resend a batch:

1. From the main screen of Bp Premier, select Management > Online Claiming. The Online Claiming screen will appear.
2. Click Check for payments in the top left. Bp Premier will update sent batches with the latest payment information.
3. Select the unpaid batch in the top half of the screen that you want to resend.
4. Select File > Resend batch. The Resend batch screen will open, showing the services in the batch.



5. Confirm that you have selected the correct batch and click Send batch. Bp Premier will resend the batch to Medicare and update the Online Claiming screen.
6. Run Check for payments again the next day to see if the batch has been successfully processed.

Troubleshooting a whole unpaid batch

If your practice sees that a batch has remained unpaid for an unreasonable period, check your Medicare setup for the following.

If a Medicare batch in Bp Premier is marked as 'unpaid', but Medicare have manually made the payment to the practice account (that is, outside of the regular online patient claiming workflow), the payment has not been transmitted electronically and the claim will remain outstanding. This is not a common scenario, but does happen.

To record such a payment, you must resend the claim, recreate a single-claim batch, and record the Medicare payment against the batch. The invoice in the billing history will be correctly updated.

1. Resend the claim:
1. Select Management > Online Claiming or press Ctrl+F9 to open the Online Claiming screen.
2. Record the batch number for the claim still marked as 'unpaid'.
3. Double-click the batch with the unpaid claim, and double-click the voucher for the claim marked unpaid.
4. Select Resend and click Process. Click OK.
2. Recreate a single-claim batch:
1. Select Management > Manual Direct Bill Batches. The Direct Bill Batches screen will open.
2. Select File > New Batch to open the Direct Bill Batch screen.
3. Select the same Provider as the batch from step 2.
4. Deselect all vouchers except the voucher for the claim marked unpaid. Click Print & Save. You will return to the Direct Bill Batches screen.
5. Double-click the batch you just created to open the Reconcile Direct Bill Batch screen.
3. Record the Medicare payment against the batch:
1. In the Amount Paid field, enter the amount paid by Medicare. You may need to accept the fee if Medicare has paid less than the amount claimed.
2. Enter the date Medicare paid the claim into the Date paid field. Tick Direct credit and click Save.
3. Select Management > Patient Billing History or press Shift+F6 to open the Billing History for the patient. Tick Show payments/deposits. The invoice should now be updated to 'Paid'.

Last updated 22 June 2022