Resubmitting Medicare/DVA Claims

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  • Updated 3 years ago
There are a number of reasons why a Medicare or DVA claim may be rejected when submitting Online Claims through the Medicare Online Claiming system.

The most common reasons for rejected claims are:

  • The service has already been paid under a previous Medicare/DVA claim.
  • Maximum number of services has already been paid for the patient (eg. Medicare EPC).

  • The submitted patient Medicare/DVA details do not match Medicare/DVA records.

  • Incorrect Item Code attached to the claim.

  • The practitioner providing the service has not been properly registered for online claiming, or has not been registered to submit online claims from that location.

  • Missing information necessary to claim (eg. referring doctor provider number, date of referral or details of the injury treated for DVA white card holders).

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.

 

Step 1 – Locating the claim

Go to the System menu and select Medicare/DVA Claims.

You will now need to locate the unsuccessful claim. The claim will normally 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 can be matched against the transaction listing within the patient's file to ensure you have the correct claim selected.


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.

 

Step 2 – Resubmitting 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 original transaction.

 Locate and highlight the claim within Medicare/DVA Claims, and select Delete.


It is recommended that you contact Medicare/DVA to confirm resubmission is the correct course of action before resubmitting the claim. Please note if Medicare/DVA delete the claim from their system, you will no longer be able to delete the claim using Front Desk. If necessary, it is important that the claim is deleted within Front Desk first, before being removed by Medicare/DVA.


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.

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Jamie, Official Rep

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Posted 4 years ago

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Lin

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This is only applicable if you utilise Online Claiming and not Easyclaim ?  We use Easyclaim because I could not get the Online claiming to balance against the amounts received and I could not ascertain which had been paid & which hadn't from the reports.   When I go into Medicare?DVA Reports it states "no reports available'.  Is there anyway of doing this when you utilise Easyclaim as the only way I can resubmit it now is to zero out the original transaction and enter a new transaction which while this isn't often it is messy & throws out the stats.
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Timothy, Business Care Manager

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Medicare / DVA reports are only available for Medicare Online directly in Front Desk.  If you require reports for EasyClaim, these can only be obtained outside of Front Desk and you need to have Medicare setup access to the Health Professional Online Services (HPOS) website. Contact Medicare on 1800 700 199 for more info.

<< We use Easyclaim because I could not get the Online claiming to balance against the amounts received and I could not ascertain which had been paid & which hadn't from the reports.>>

Medicare Online is a better interface than EasyClaim and the one recommend by Medicare for electronic claiming for any practice that submits more than the occasional claim and for anyone who wants to make DVA claims.  The 2 systems have different implementations in relation to how items are paid off in Front Desk.

For Medicare (and DVA) Online when you submit a claim for an item it is not immediately marked as paid though the claim has been transmitted to Medicare, as claims are not processed in real time but generally within 48 hours.  Each day, we recommend that you request a report from Medicare by clicking ‘Process’ on the Medicare / DVA Claims window.  At this time any new paid items by Medicare will automatically be processed in Front Desk and payment automatically reconciled on each patient's file.  For items that have not been paid, a reason is provided by Medicare and an opportunity is provided to make changes and re-submit. You will also have access to up-to-date Medicare payment reports to help with any reconciliation.

Alternatively, Easyclaim Bulk Bill claims are submitted through your Tyro/HICAPS terminal. Once the claim is submitted, the item is added as an outstanding amount on the patient's file. The key difference is that there is no utility in Front Desk to automatically check for claim updates, and therefore no automatic reconciliation of payments once processed by Medicare. Note that you should not assume that an Easyclaim Bulk Bill Claim will be paid simply because it is accepted by your terminal as this is only a confirmation it has been received by Medicare for processing at a later time. You do need to manually reconcile these payments on each patient's file.

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Lin

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Re Online claiming: I can see the process that is supposed to work and it would appear to be a lot less work then looking up Medicare reports and individually receipting however the section " For items that have not been paid, a reason is provided by Medicare and an opportunity is provided to make changes & re=submit.  You will also have access to up-to-date Medicare payment reports to help with any reconciliation".  This didn't happen for us.  Reports would state all was processed and paid but we didn't receive the corresponding amounts in the bank.  Also when you tried to work out which amounts hadn't been received, the reports in no way corresponded with the amounts received in the bank so there was no way of telling which hadn't been received but according to Medicare reports all was fine.  It was a total fail.   At least with Easyclaim I know which are paid and which aren't and why. 
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Stuart Blyth

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Hi Lin

Its strange you are having an issue with On line claiming, we find it a fantastic time saver and highly accurate. We have 6 sites and run a few hundred transaction claims a week through it and it takes minutes to balance most weeks. The reports are great especially now the provider numbers are shown to quickly match up against the bank statements.

I would highly suggest working through your issues with the help desk so you can get on track and take advantage of this great feature in FD, good luck!

Stuart  

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Tony Taddeo, Managing Director

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Our Medicare Online implementation is widely used and we are unaware of any reconciling issues if used correctly. Our users should be using Medicare Online where possible.

I will recap how the payment – reconcile process works.

To reconcile Medicare Bulk Bill and DVA payments, the first step is to get the processing and payment reports from Medicare. This should be done daily, and it’s done by simply clicking “Process” on the Medicare / DVA Claims window. This downloads all available payment reports for Medicare for any outstanding claims, and automatically pays off the transactions in Front Desk. Any claims which can’t be paid are marked as incomplete and you can view the reasons for non-payment by selecting a claim and clicking the “Reports” button.

You can then use the Medicare / DVA Report under the Reports menu. This allows you to select a date range for bank deposits, and groups payments by Bank Account Name / Number / BSB, and then by Payment Run Date, Payment Run Number, and Payee Provider Number. This gives you enough information to easily reconcile with a bank statement. Deposit amount totals are included (for each payment run), and below each payment you can see details of the claims that have been paid.

Lin - As you already have Medicare Online installed, I suggest you try it again using the above instructions. If you still feel the reconciling process is not working for you, please contact us by opening a support case.

www.smartsoft.com.au/support

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Julienne Locke

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We too run about 2-300 transaction through Frontdesk Medicare portal.  The only thing i find frustrating is the DVA reports (for example) process off today yet the run money $$ doesnt appear in the back account until tomorrow.  Where as Medicare process off the day the money goes into the bank account.  We have to be careful around end of BAS period and EOFY so that what Frontdesk says has been paid is actually in our accounts as $$ received.
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Andrew, Community Manager

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Hi Julienne

Unfortunately we are only provided information on when the payments were sent by Medicare/DVA, and we can't control or see when it actually enters your bank account. I'm not certain why this might be different between Medicare and DVA, but they could be making payments through different banks or systems.

On the plus side DVA payments before online claiming would take weeks to be received, so things have certainly improved. 
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Julienne Locke

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Oh its definitely a positive and it was the reason we chose Frontdesk over other software packages at the time.  We would never entertain changing systems due to the investment we have in FD.  Gone are the days of me hand filling in over 100 forms per week on my couch from home.... and then posting them... Let alone trying to find an error in a batch!