Enterprise Patient Verification
Enterprise Patient Verification [EPV] provides the facility to verify, prior to claim submission, that the:
Patient is eligible for claiming Medicare benefits
Patient is known to the Health Fund
Patient holds a "hospital level" of cover
EPV supports the verification of multiple patients in a single request as per the following:
This verification can be requested for up to 1000 patients per transmission.
Medicare Card and Health Fund Card details must be held in Patient Details prior to doing an Enterprise verification.
Responses for EPV requests may not be available for up to 72hrs.
A Time out determines when a response is returned after the submission of the request.
To perform this function in Impulse the patient must be entered in the Appointment book.
Generate an EPV
On The main screen of Impulse Top Taskbar
Select Wait\App\Enterprise OPV
- Click Add
- Enter Group Source: Appointments
- Select Start and Finish date
- Select The EPV form the groups listed:
- Medicare: Medicare card Only
- Medicare and Fund: Both Cards
- Fund: Health Fund Card Only
- Veterans: DVA cards
- Concession: Concession cards only
- Tick to save.
Details of the Patients Selected will appear in the Enterprise OPV List Details.
Patients listed can be deleted from this list prior to submitting EPV by selecting the patient and clicking the delete button.
Click Submit All button at top of screen to send to Medicare.
The Enterprise Group Session will record the transmission on screen.
Prior to doing a Status Request you can edit and change the time out which by default is set at 24. 12 is the least time out permitted.
It is possible to select Medicare [PVM], Fund [PVF] and Medicare and Fund [OPV] in one transmission.
DVA and Concession EPV must be done separately.
Once an EPV Group Session is submitted a Status Request Must be done prior to requesting the Report.
- Select The Report and Click One Status button.
- When the Status is READY the Report can be retrieved.
Details of the Report Will Populate the Enterprise OPV List Details.
The following Medicare Codes may be returned.
0 - Patient Eligible for Medicare.
8003 - Patient is currently ineligible for Medicare.
8005 - The individual has been matched using the submitted data however differences were identified. Please check the information returned and update your records.
8009 - The name supplied for this individual differs from that held by Medicare. This individual only has one name. Please check the name and update your records.
9626 - The patient is or was covered under the Reciprocal Health Care Agreement.
9633 - A new Medicare card has been issued. Please update your records and ask the patient to use the new card number for any future claims.
9635 - Check Servicing Provider.
9649 - Patient Eligibility Cannot be Determined.
9650 - Patient data supplied failed validation checks.
9665 - Cannot uniquely identify Patient from information supplied.
9675 - Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected.
The following Health fund codes may be received
0 Patient is eligible to claim with Health Fund specified in the request
8007 Membership matched. Please ask patient to contact the Fund
8008 Membership matched but provider must contact the Fund
8009 The name supplied for this individual differs from that held by Medicare. This individual only has one name. Please check the name and update your records.
9009 This transaction type is not permitted from this type of client. Health Fund Loactions cannot request a PVF[Patient Fund verification].
9662 Provider must contact Fund
9663 Check Fund and Membership Card details
9664 Check Patient details. If correct, check Fund and Membership Card. If correct, the name known to the Fund may differ from that held by Medicare OR Patient Unique Identifier has not been supplied [if applicable to Fund].
9665 Cannot uniquely identify Patient from information supplied. Please resubmit with additional information and\or confirm details with patient.
9666 Patient must contact Fund
9667 Health Fund Membership cover suspended or cancelled
9668 Medical claims are not covered for this patient. Patient must contact Fund
9669 Membership matched however calims for Patient cannot be submitted using this channel at this time. Patient to contact Fund.