Medicare Patients Claim View

Patient Claims
Access from the Main Menu by selecting Medicare | Patient Claims or select the Patient Claims speed button.

Patient Claims are Medicare Claims lodged by patients who have received professional medical services, but have not assigned their rights to Medicare benefits to the Servicing Practitioner.

Assessed View

When a Patient Claim is lodged and fully assessed, immediately by Medicare Australia, a Statement of Claim and Benefit is generated and these patient Claims can be viewed in Assessed.

Patient Claims Interactive (PCI) allows real-time processing of a single claim and is available during Medicare Australia operating hours.

Patient Claims Interactive is Real time processing.

The Claim transmits, is assessed, and returns an outcome to the sending Location as a single process. This is done in the presence of the patient.

As Patient Claims are claims that are lodged in real time, at the time the patient is billed, and the invoice generated, the patient claim is lodged.

When a Patient Claim is lodged and fully assessed, immediately by Medicare Australia, a Statement of Claim and Benefit is generated and is handed to the patient.

Referred to Medicare

A Lodgment Advice is printed when the claim is received in real time but requires further assessment by Medicare as it has an acceptable error.

The Claim Status is MEDICARE_PENDABLE.

The Claim is put in Medicare\Patient Claims\Referred to Medicare.

This Lodgment Advice must be given to the Patient.

Corrections

A Claim with an Unacceptable error can be relodged again and pended.

This Lodgment Advice must be given to the Patient with the error code and the Claim is put in Medicare\Patient Claims\Corrections.

Where it can be corrected in Patient details, this should be done and the Patient claim relodged immediately.

Claim is put in Medicare\Patient Claims\Referred to Medicare if successful.

If the Claim contains an Unacceptable instance and the claim will not lodge ,the servicing location will be made aware of this immediately and will need to journal out this claim and re-invoice correctly.

Cancelled Lodgment

These claims Have had a Same day delete applied.

Not Available in PRODA version

Patient Claims Store & Forward (PCS) which can contain multiple claims and multiple PCS may be contained within a single transmission, may be submitted at any time unless advised otherwise.

This view is to very quickly ascertain;
Claims that have not transferred successfully for whatever reason.
Claims that have been Assessed immediately and a Statement of Claim and Benefit was printed.
Claims Referred to Medicare and a Lodgment Advice was printed as claim had acceptable error level.

Correction: These claims have an unacceptable error by can be corrected depending on the error code received and then relodged. A Lodgment Advice will print as claim will go to Medicare pend and will transfer to Referred to Medicare if not rejected.
Claims stored for later transmission if Patient Claim Store and Forward Option
was selected.