Online Claiming: Patient claiming

Quick Reference Guide

This stepthrough article is for practices that submit claims from private practice billing through Medicare Online, and describes how to:

  1. Activate Medicare online claiming for patient claiming.
  2. Bill an invoice to a patient or Head of Family and send the claim to Medicare Online.
  3. Review sent claims for payment status.
  4. Correct common unpaid scenarios, and the actions the patient may need to take.
  5. Adjust an invoice and resubmit a claim: same-day and after.
  6. Troubleshoot some common errors that may occur during online patient claiming.

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:

 

Enable in Setup > Configuration

Enable patient claiming 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. Enable online patient claiming

  3. From the list of check boxes at the top of the screen, select:

    4. Activate Online Private Patient Claiming

    Always select this option to enable patient claiming online.

    Always send private patient claims by best available method

    Tick this option to default the Payments screen to:

    • Send via Patient Claiming if Easyclaim is not configured.
    • Send via Easyclaim if Activate Easyclaim Private Patient Claiming is also configured here.

Invoice and claim

  1. Finalise a visit or Create an account as you normally would for a private account. Set the Bill to: field to ‘Patient’ or ‘Head of family’.

    2. Bill to for patient claiming

  2. Select Pay Now to display the Payment details screen.
  3. Enter the payment information and allocate the payment amount to the invoice.
  4. Tick Send via Patient claiming.

    5. Tick Send via Patient Claiming

    TIP  This option is checked by default if the Always send private patient claims by best available method checkbox is ticked on the Configuration > Online claiming screen.

  5. Click Process. Bp Premier will pop up a notice that the claim is being transmitted to Medicare.
  6. Click Close to exit the Payment details screen.

Most claims are successfully processed by Medicare, and if the patient fully paid the invoice, the refund to the patient will be made via EFT to the patient’s bank account details stored with Medicare within the next 2-3 business days.

Pendable claims in Saffron SP3

In Saffron SP3, if a claim requires further assessment by an operator, an error will appear indicating that the claim has been marked as pendable, and adjustments may need to be made to the invoice to be accepted by Medicare.

Click Yes in the error message to adjust the invoice. The Account details screen will appear.

You will be able to edit the following:

  • Service time (if applicable)
  • Not normal aftercare
  • In hospital and Hospital Facility Name
  • Invoice Notes
  • Referral details if applicable
  • service details
  • restriction code
  • self deemed.

Once the claim has been adjusted, click Save to resubmit.

NOTE  The adjusted claim must be sent within one hour of submitting the original claim.

Claim Outcomes

This table lists the possible outcomes:

Outcome

Form printed

Claim status

Bp Premier has validated the claim submission and determined there are errors that require user correction.

n/a

n/a

Medicare processes the claim and pays the patient into the specified bank account.

Statement of Benefit

Paid

Medicare has been unable to process the claim automatically and has been referred to a person for manual processing.

Lodgement Advice

Manual

Medicare have rejected the claim as there was some invalid data transmitted.

None

Rejected

Medicare did not receive the claim due to transmission errors. The claim has been stored for retrying later.

None

Unsent

What do I do next?

If Bp Premier reported validation errors, the claim is still unsent. You can correct the error and click Process again to resubmit the claim.

If Medicare cannot process the claim automatically and assigns the claim for manual investigation, no further action by the practice is necessary. Give the patient the Lodgement Advice that printed. Until the claim is assessed, the patient will not know if they will receive a rebate. The patient should wait for a few days to see if they receive their rebate. If they do not, he or she should contact Medicare directly with details from the Lodgement Advice.

If Medicare cannot process the claim due to invalid data or Medicare rules, for some rejection reasons you can correct the claim and resend the same day. If the patient has no bank account associated with Medicare, the patient will need to contact Medicare directly to obtain their rebate.

If Medicare is unable to process the claim at the time (usually because the internet is down or Medicare’s services are offline), the claim will be stored for processing. You can send unsent claims from the Patient Claiming > Unsent claims screen.

 

What forms are printed?

Three different forms will print depending on the status of the claim. The status of the claim can be seen on the Patient Claims screen (select Management > Patient Claiming from the main screen).

The patient address on the form and all correspondence from Medicare will be the claimant’s address held by Medicare.

BPS Receipt - REJECTED

The standard Best Practice Software Tax Invoice or Receipt will be printed if the claim is rejected by Medicare; if there are issues with validating the patient information or with bank account details, for example. The patient will have to obtain their refund from Medicare or register a bank account with Medicare.

Statement of Claim and Benefit Payment - PAID

This report ( which replaces the BPS Receipt) indicates that the refund to the patient has been paid:

  • The report indicates 'This claim has been: ASSESSED'.
  • The statement shows details about the transmission and will include the value of the patient contribution and the amount of the benefit paid.
  • The Payment details section shows that the account has been fully paid and how Medicare will pay the patient.
  • The Patient Claims screen will show the status of the claim as ‘Paid’.

Lodgement Advice – MANUAL

This report will replace the BPS Receipt and will be generated if the transmission is successful but the patient part paid the account or there has been some issue with the payment.

If the report says ‘This claim has been: REFERRED TO Medicare Australia':

  • Information entered on the claim requires manual processing by Medicare staff. The patient would have to liaise with Medicare for further information. The Lodgement Advice will contain a reference number.
  • The Patient Claims screen will show the status of the claim as ‘Manual’.

If the report says ‘This claim has been: STORED FOR LATER TRANSMISSION':

  • Transmission was not possible due to a system problem. The items will be placed in a storage area for later transmission.
  • These claims can be found in the Patient Claims screen under View > Unsent claims.
  • The statement shows details about the transmission and will show the Patient Contribution but will not show how much Medicare will pay the patient.
  • Payment details section will show whether the patient fully or partly paid the invoice and how Medicare will pay the patient.

 

Review rejected and unsent claims

To open the Patient claims screen, select Management > Patient claiming from the main screen. This screen shows the status of all patient claims sent for a selected day.

Patient Claims

Possible statuses are:

Status

Description

Paid

Medicare has processed the claim and paid the patient into the specified bank account.

Manual

Medicare has been unable to process the claim automatically and has been referred to a person for manual processing.

Rejected

Medicare have rejected the claim as there was some invalid data transmitted.

Deleted

The claim has been deleted by practice staff. Tick Include deleted to see these claims.

Resent

Claim has been resubmitted to Medicare.

Unsent

Claim has not yet been sent.

You can delete, resend, view unsent claims, and reprint the statement of benefit for a sent claim from this screen.

Send unsent claims

You can resend claims with a status of ‘Unsent’. You can also print a list of unsent claims.

  1. From the Patient claims screen, select View > Unsent claims. The Unsent patient claims screen will appear.

    2. Unsent Patient Claims

  2. View Patient details for a claim, Remove a claim from the unsent list, or Send an unsent claim.

Delete a claim

When using patient claiming, you can only delete claims on the same day of transmission.

From Patient Claiming, right-click on a claim and select Delete claim, or select File > Delete claim from the menu. The system will contact Medicare electronically and cancel the claim, and the claim will be removed from the Patient Claiming screen. You can view the claim by ticking Include deleted.

 

Troubleshooting

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

Medicare Code

Description

Cause

Resolution

1004

A session could not be established.

 

Install the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

1006

PKI Login failure

The Medicare Certificates have expired.

Re-import the Medicare certificates from C:\Program Files\Best Practice Software\BPS\MedicareCerts.

See Configuring Medicare Certificates for more information.

1011

Unable to find Java Virtual machine library

Java is not installed correctly on the machine.

Install the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

1014

Unable to locate the EasyclaimAPI class

Environment Variables are incorrect.

Install the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

1705

Secure Failure

Site Certificates have expired.

Check the Site Certificate Expiry Date.

If the site certificates haven't expired, tried recreating the certificate store in a new location. Give the Windows user group 'everyone' full control to the store as well.

See Configuring Medicare Certificates for more information.

1999

An undefined error has been detected in Java API

Incorrectly configured environment variables.

Edit Environment Variables > user variables to make sure that TMP and TEMP are the only user-defined variables. 

Your IT support can assist you with editing Windows user and environment variables.

2008

No business object currently exists for the supplied Session ID

Install the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

2015

No voucher exists within the session for the supplied VoucherSeqNum

Multiple Thumbprint files exist.

  1. In a Windows File Explorer, browse to the folder C:\Users\username\.medicareonline\.
  2. Delete the contents of this folder and resubmit the claim.

2017

The Payee Provider specified is the same as the Servicing Provider

They've got Payee Providers in the System with the same provider numbers.

In Bp Premier, go to Setup > Configuration > Payer Allocation and make sure that provider allocation is set up correctly.

2021

Invalid directory or directory not found

Client can’t find the HIC.psi file.

  1. In Bp Premier, check the path listed as Path to certificate store in Setup > Configuration > Online Claiming.
  2. Navigate to that path in Windows File Explorer.
  3. If you are prompted for authentication when you attempt to access the path to certificate store, the path has NOT been shared for the Windows usergroup 'Everyone'. Give the user group 'everyone' full permissions for the path and retry.
  4. If the path to certificate store couldn't be found, check that the path is correct on the Bp Premier server and confirm that the path is shared to the user group 'everyone'.

2027

The report does not exist for the given selection criteria

Multiple Thumbprint files exist.

  1. In a Windows File Explorer, browse to the folder C:\Users\username\.medicareonline\.
  2. Delete the contents of this folder and resubmit the claim.

2054

Date of service is inconsistent with other dates set

Patient's date of birth.

Check that the date of birth is correct in patient demographics.

The last modification to a patient demographics is shown down the bottom of the window.

3001

Communication error. Check that you have a current internet session. For further assistance contact the Medicare eBusiness Service Centre.

Potential problem with the anti-virus software

There may be an issue with your anti-virus software, or internet service provider.

Best Practice Software cannot resolve this issue. Contact your anti-virus vendor or Medicare eBusiness.

3004

The request cannot be dealt with at this time because real-time processing is not available or the system is down. Contact the Medicare eBusiness Service Centre for further assistance.

Reinstall the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

If that does not resolve the issue, edit Environment Variables > user variables to make sure that TMP and TEMP are the only user-defined variables. 

If that does not resolve the issue, the Medicare servers may be experiencing high volume issues. Try resubmitting at a later time if possible.

This error message has also been caused by some antivirus software. If an OPV check works but the transmission still fails, try temporarily disabling your antivirus or firewall and resubmit.

3008

The sending Location could not be identified at the Client Adaptor

  1. In a Windows File Explorer, browse to the folder C:\Users\username\.medicareonline\.
  2. Delete the contents of this folder and resubmit the claim.

9003

The provider is identified as inactive for Online Claiming purposes. Contact the PKI Customer Service Centre for assistance.

The provider is not marked as 'Active' in the Medicare Servers. This may be due to the registration not being completed correctly.

Contact Medicare e-Business to confirm the provider is active. You may need to complete a Change of Bank Details form again.

9007

The Location is not authorised to undertake the function on the date of transmission. The transmission has been rejected. Contact the Medicare eBusiness Service Centre for further assistance.

If your practice has upgraded to Saffron SP2, You may receive this error if Medicare Online has not been linked as a service provider to your organisation in PRODA.

Follow these instructions on the Services Australia website to Link Medicare Online to your organisation in PRODA.

If you continue to receive this error, call or email the Medicare eBusiness service centre on 1800 700 199 or ebusiness@servicesaustralia.gov.au.

9010

The software product used to create the transaction is not certified for this function. Contact the Medicare Australia eBusiness Service Centre for further assistance.

Best Practice is trying to transmit using another products Medicare Module.

Reinstall the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

If that does not resolve the issue, edit Environment Variables > user variables to make sure that TMP and TEMP are the only user-defined variables. 

If the user variables Easy_Parm_3 or Easy_Parm_4 exist, AND your practice does not use a proxy server for online claiming, delete these variables.

9111

If createCryptoStore - a PSI Store already exists in the nominated folder. Otherwise a problem has been encountered using PKI services. Repeating the function call should be successful.

Unable to access the certificate store in the correct manner.

This issue can indicate a few causes, such as MAOL not set up correctly. However, this message is usually related to permissions.

  1. In Bp Premier, check the path listed as Path to certificate store in Setup > Configuration > Online Claiming.
  2. Navigate to that path in Windows File Explorer.
  3. Give the user group 'everyone' full permissions for the path.
  4. Restart Bp Premier and retry.

This issue can also be caused by not enough space on C:\ Drive.

9119

The provider is identified as inactive for Online Claiming purposes. Contact the PKI Customer Service Centre for assistance.

The provider is marked as inactive in the Medicare System. Their provider number may not be registered or updated.

Best Practice Software cannot assist with this issue. Contact Medicare to reactivate the provider.

9121

Desecure failure at Medicare. Contact the PKI Customer Service Centre for assistance.

Certificate cannot verify when attempting OPV.

Site certificate imported may have used SHA-2 encryption. You will need SHA-1 site certificates for Medicare Online Claiming.

If these have not been supplied as part of your original site certificates, contact Medicare eBusiness to obtain SHA-1 site certificates for use with Bp Premier.

9123

The HCL certificate used to sign the transmission is not the certificate currently registered against the location ID.

Only one site certificate can be linked to a single minor ID.

Your site may have received a new site certificate (for example, because the practice has changed owners) and the old certificate has not yet been removed at Medicare's end.

Contact Medicare eBusiness to remove the old certificates.

9127

Requested Location Encryption Certificate not found in the PSI Store

 fac_encrypt.p12 was not imported correctly or at all.

Re-import the Medicare certificates from C:\Program Files\Best Practice Software\BPS\MedicareCerts.

See Configuring Medicare Certificates for more information.

9201

Invalid format for data item

Invalid characters in patient name

Characters accepted are: alphanumeric characters, apostrophes, hyphens, and spaces. However, spaces must not appear immediately before or after apostrophes and hyphens.

The issue is usually caused by leading or trailing spaces as per the examples below:

  • O’Toole – Valid
  • O’ Toole – Invalid (one or more spaces after apostrophe)
  • O ’Toole – Invalid (one or more spaces before apostrophe)
  • Anne-Marie – Valid
  • Anne -Marie – Invalid (one or more spaces before hyphen)
  • Anne- Marie – Invalid (one or more spaces after hyphen)
  • Anne - Marie – Invalid (one or more spaces before and after hyphen)
  • Robert AKA Bob – Valid
  • Robert (Bob) – The parentheses characters '(' and ')' are not valid.

SQL queries are available that are supplied with Bp Premier and can be imported into the Database Searchtool to search for patients with invalid names.

9202

Invalid value for data item. The data element does not comply with the values permitted or has failed a check digit check.

Check that the Windows system date and time is correct and set to the correct time zone.

Reinstall the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

9217

Authorisation date is a date in future

Potentially a problem with the Time Zone set on the computer that has created the service.

Check that the Windows system date and time is correct and set to the correct time zone.

9308

Referring Practitioner's Provider Number must be supplied.

The Provider number for the referring Doctor hasn't been updated in the Contacts screen.

Enter the Provider Number into the Contact Details for the referring Provider.

9325

Service type not supplied

Reinstall the Medicare module.

See Set up Online Claiming for single Minor ID for more information.

Edit Environment Variables > user variables to make sure that TMP and TEMP are the only user-defined variables. 

If the user variables Easy_Parm_3 or Easy_Parm_4 exist, AND your practice does not use a proxy server for online claiming, delete these variables

9342

The Payee Practitioner supplied is the same as the Servicing Provider. If both are the same, only one of the Servicing Provider should be completed.

They've got Payee Providers in the System with the same provider numbers.

In Bp Premier, go to Setup > Configuration > Payer Allocation and make sure that provider allocation is set up correctly.

9602

This claim cannot be lodged through Medicare Easyclaim. Please submit the claim via an alternative Medicare claiming channel.

OTS has advised that this can be caused by an issue with the Medicare card number.

The claim must be manually submitted to Medicare.

9641

A restrictive condition exists

 

Ensure that you have entered the correct restriction codes under Add item when creating the invoice, such as 'Separate Sites', or 'Not related'.

See Restriction codes for more information.

 

Bp Premier crashes without generating any errors or logs when you perform a Check for Payments or an OPV lookup.

Java has not been installed correctly.

Uninstall the old version of Java first, then run the MAOL utility to re-install Java.

See Set up Online Claiming for single Minor ID for more information.

See Updating JAVA on Bp Premier server and workstations for more information.

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.

A problem has been encountered accessing PKI services. Ensure that the Medicare Australia and site certificates have been imported and that they have not passed their expiry date.

Step

Knowledge base articles

1. Ensure that all five Medicare certificates are present in Setup > Configuration > Online Claiming.

Configuring Medicare Certificates

2. Ensure that the two site certificates are present in the same location.

Configuring Medicare Certificates

3. Ensure that all of the certfiicates have a valid start date and expiry date.

Check NASH and Medicare certificates for expiry

4. Ensure that the MinorID in Setup > Config > Online Claiming > Check certificate expiry has been entered.

See Set up Online Claiming for single Minor ID for more information.

Last updated 02 February 2022

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