Patient Claims Interactive Billing and Same Day Delete

Patient Claims Interactive Billing and Same Day Delete

Patient Claims interactive.[PCI]

This is a claim lodged for the Patient, in real time, at time of service. 
The patient does not assign their Medicare rights to the Servicing Provider.

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. 

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. 

A Claim with an acceptible error can be relodged again within 1 hour of transmission and pended.

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

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

Claim is put in Medicare\Patient Claims\Assessed if Medicare transmission is successful and a Statement of Claim and Benefit will print.

If relodged Claim is Medicare_Pend it is put in Medicare\Patient Claims\Referred to Medicare  for an assessor to look at. This Lodgment Advice must be given to the Patient.

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.
The Claim if in Medicare\Patient Claims\Corrections can be relodged again if patient details can be corrected. EG. Old patient Medicare card.
If Fully Assessed a Statement of Claim and Benefit will print.
If the Claim Status is MEDICARE_PENDABLE . The Claim is put in Medicare\Patient Claims\Referred to Medicare.
This Lodgement Advice will print.  Relodge again within 1 hour of transmission and Claim will be Medicare_pended.

Medicare Rejected Patient Claims
If an Unacceptable Error is received from the Medicare Portal a Lodgement advice will print with the error code and clearly state Medicare_Rejected
Patient Claim can then be viewed in Medicare\Patient Claims\Correction or Cancellation
Rejected Claims with unacceptable error must be journaled and redone or if error text states “"This claim cannot be lodged through this channel. Please submit the claim via an alternative
Medicare claiming channel." Hand the Invoice\Receipt to the patient.

If the invoice is not fully paid Medicare Australia sends the Servicing Provider cheque to the Patient to forward to the Doctor.

Billing and Lodging Patient Claim

  1. Search and Select Patient 
  2. In Patient Details do a PVM to ensure Medicare Card is ELIGIBLE
  3. F8 to open billing screen
  4. Location, Provider and Fee type will populate if these details were entered in Patient details
  5. Service Date will default to Current date
  6. Fee type Must be Private Fee type. Eg MS or P fee type
  7. Proceed with Billing item number
  8. Down Arrow for further item number entries
  9. Select Pat.C.Online Button at Bottom of screen

Patient Payment Method

Pay
  1. Full:          The account is paid in Full
  2. Not Full:   Gap Payment only or No Payment

Receive Medicare Benefit By
  1. Account Details held By Medicare:   Payment directly to Patient bank account held by Medicare Australia
  2. Account Details In Impulse:          Patient or Payer Bank details can be entered in Patient details\Accounts and will be transmitted to Medicare Australia.

Cheque or Statement Sent to
  1. Address held by Medicare : Use This option for all Patient Claims
  2. Claimant address:  Must only be used on Medicare request or if Third Party Paying Account
Click Select

Payment  

Full Payment
  1. Methods of Payment Screen opens
  2. Select Method by which payment is being made
  3. Complete all Details
  4. Click Pay Button

Print Receipt
  1. Click No But Save as Though We Did
  2. Claim is Lodged with Medicare Australia
  3. Statement of Claim and Benefit Prints
  4. Or Lodgement Advice will print
Medicare Pending or Rejected Patient Claims
If an Unacceptable Error is received from the Medicare Portal a Lodgement advice will print with the error code
Patient Claim can then be viewed in Medicare\Patient Claims\Correction or Cancellation
Rejected Claims with unacceptible error must be journaled and redone or if error text states
"This claim cannot be lodged through this channel. Please submit the claim via an alternative
Medicare claiming channel." Hand the Invoice\Receipt to the patient.

Medicare Pend
If an Acceptible Error code is received from the Medicare Portal a Lodgment advice will print with the error code.
A Message to screen will also state that the Patient Claim is Medicare_Pendable. and this will be transferred to a Medicare Assessor.
Patient Claim can then be viewed in Medicare\Patient Claims\Referred to Medicare. 
Select Claim and Click Relodge Claim. Lodgement Advice prints this  claim will be transferred to a Medicare Assessor.
Where the patient Claim can be corrected in Impulse, after this has been completed and saved, it can be relodged and will Go to Medicare Pend.
Patient claim will be in Medicare\Patient Claims\Referred to Medicare.
If Statement of Claim and Benefit prints Patient claim will be in Medicare\Patient Claims\Asssessed.

Not Full: Gap Payment 
  1. Payments Screen Opens
  2. Select One invoice
  3. Pay Gap 
  4. Click Receipt
  5. Select Payment Method
  6. Complete details
  7. Click Pay Button
Print Receipt
  1. Click No But Save as Though We Did
  2. Claim is Lodged with Medicare Australia
  3. Statement of Claim and Benefit Prints
  4. Or Lodgement Advice will print
If an Unacceptable Error is received from the Medicare Portal a Lodgement advice will print with the error code
Claim can then be viewed in Medicare\Patient Claims\Correction or Cancellation

Not Full: NO Payment
  1. Payment Screen opens
  2. Select Button Lodge Without Payment. [ Bottom Taskbar]
  3. Claim is Lodged with Medicare Australia
  4. Statement of Claim and Benefit Prints
  5. Lodgement Advice will print 
If an Unacceptable Error is received from the Medicare Portal a Lodgement advice will print with the error code
Claim can then be viewed in Medicare\Patient Claims\Correction or Cancellation

All Patient Claims Interactive Lodged with Medicare Australia will be in Medicare\Patient Claims

Medicare\Patient Claims : Main Screen Of Impulse Top Taskbar

Same Day Delete

This option can be used where a mistake has been made and you wish to delete the claim lodged with Medicare and re – invoice and lodge the claim again with corrected details.
Assessed 
If a Statement of Claim and Benefit printed 

  1. Select the Patient from the list
  2. Tick the box next to the Patient
  3. Click the button 1-Same Day Delete.
  4. Select the Reason for the Delete from the drop down box
  5. Click Select
  6. This will transmit to Medicare Australia
The patient record will be time stamped with the reason code and the date time it was lodged with Medicare.

Print Invoice\Receipt If you Have Selected the Same Day Delete Option 'Other'

  1. Right Mouse Click on patient name to go to Patient Details
  2. Select System\Account Enquiry
  3. Select Invoice
  4. Print  patient an Invoice\Receipt and they will have to go to A Medicare Office to claim rebate

Journal Invoice \Receipt After Same Day delete Option Selected [ Excludes Other]

  1. Right Mouse Click to go to Patient Details
  2. Select System\Account Enquiry
  3. Select Invoice
  4. Patient\Journal
  5. Reverse Payment
  6. Select Receipt
  7. Click Reverse payment
  8. Click OK
  9. Select Invoice Private
  10. Select Invoice
  11. Reverse Invoice.
  12. Click OK
This claim will now be removed from the Patient Claims\Assessed view

  1. Re- bill the patient with correct details.
  2. Click Pat.C.Online
  3. Complete details
  4. Lodge Patient Claim
The following Options Cannot have a Same Day Delete sent and you should Contact Medicare Australia 13 21 50 to delete the claim prior to redoing it

Referred to Medicare
If a Lodgement Advice printed
In Most Instances this claim will be sent to a Medicare Assessor 

Correction or Cancellation
These claims have an unacceptable error and must be corrected prior to relodgement
Or The patient is given the Invoice\Receipt and will have to go to A Medicare Office to claim rebate





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