In the event a claim has not been successful or has not returned a valid report from Medicare/DVA, the following steps will allow you to resubmit the claim.
Go to the System menu and select Medicare/DVA Claims.
You will now need to locate the unsuccessful claim. The claim may be listed under the 'Incomplete' or 'Failed' status. If you are having difficulty locating the claim, select the 'All' option to display all claims regardless of status and ensure the date range selected is appropriate.
The claim number is the best indicator you have selected the correct claim. This can be matched against the transaction listing within the patient's file.
From the Medicare/DVA Claims window, highlight the unsuccessful claim and click Reports. This will attempt to retrieve a report directly from Medicare or DVA with information on the claim status.
The 'Medicare Explanation Code' is retrieved directly from Medicare/DVA and provides basic information on the claim status. If you require further information on explanation code interpretation please contact Medicare Online Claiming support on 1800 700 199.
In the event no report is available and two business days have passed, contact Medicare support to confirm the claim has been received.
If the claim was not received correctly, confirm that the practitioner is correctly registered for Medicare Online Claiming before resubmitting.
After determining the cause of the unsuccessful claim, correct the error(s) in the patient file using the information provided by the explanation code and Medicare or DVA.
Once the error has been corrected, you are now ready to resubmit the claim.
If the claim requires resubmission, the existing claim will first need to be deleted before a new claim may be submitted using the same transaction.
Locate and highlight the claim within Medicare/DVA Claims, and select Delete.
It is recommended that you contact Medicare/DVA to confirm the resubmission before deleting the claim.
Once the claim has been deleted from the Medicare/DVA Claims window, it can be resubmitted from the Patient File using the existing transaction.
Open the patient file, and select Transactions.
Right-click the appropriate transaction and select 'Medicare Online', followed by the type of claim to be submitted (Patient Claim, Medicare BB or DVA).
Complete the Medicare/DVA claiming wizard to resubmit the claim using the corrected information.
Congratulations! You have successfully resubmitted a Medicare/DVA claim.
After waiting 24-48 hours you can then process the claim to ensure it was successful.
Front Desk 2013 - Practice Management System includes support for integrated Medicare/DVA online claiming. This functionality allows for highly efficient Medicare and Department of Veteran Affairs Allied Health claiming, but is reliant on the correct entry of information in the patient file and meeting Medicare/DVA requirements.
In order to submit Medicare/DVA claims successfully, please ensure the following information is entered into the Patient File correctly.
Open the patient file and select the General tab.
Click the 'Full Name' button, and ensure the correct information is entered into the appropriate fields. Nicknames or preferred names must be entered into the Preferred field.
Click OK to continue.
Enter a valid Address and Date of Birth. A suburb listing can be produced by double-clicking the appropriate address line.
Select a Gender, and if applicable select the required Fee Category.
The General Tab is now complete; additional information may be added if desired.
Select the Billing Details tab from the patient file.
Within the 'Print on Accounts' section of Billing Details, select Referring Doctor and either DVA Number or Medicare Number depending on the patient type.
Enter a referring doctor by clicking the browse option of the 'Ref. Dr.' field. This will allow you to either search for an existing referring doctor, or create a new referring doctor file.
Please note this is not applicable to 'Medical Specialist Referral' users, who will instead need to enter the appropriate information into the Medical Specialist Referrals tab.
Ensure the referring doctor file includes a First Name, Surname, and an 8 character provider number. Please note, if you have been given a 7 character provider number you may need to add a '0' to the beginning to claim successfully.
After selecting a referring doctor, the 'Ref. Dr.' field should appear as below:
Click the 'More...' button and enter the corresponding Date of Referral and Referral Expiry Date.
Please note, if you have not been offered a referral expiry date it should be set 12 months from the date of referral.
The Billing Details Tab is now complete, additional information may be added if desired.
Select the Medicare/DVA tab within the patients file.
If the patient is a Medicare client, enter the patient's Medicare number into the corresponding field, followed by the individual reference number. The card expiry date is not required, but can be entered for staff reference if desired.
Otherwise, if the patient is a DVA client, enter the patient's DVA number into the corresponding field, followed by the card type (gold or white).
Alternate claimant details may also be entered by selecting the 'Alternate Claimant' option if required.
Congratulations! You have successfully set up a patient file for Medicare/DVA claiming.