ECLIPSE is here to make your life a whole lot easier than it would be if you were sending paper claims to the health funds, but when you are first learning the ropes the system can seem a bit confusing and convoluted. How do you get those pesky claims to move on so you can receipt them? Well, by retrieving payment reports!
Before you begin
If you’re reading this article, assumedly you have some claims in ECLIPSE, and these might have various Claim Statuses that are not Finalised.
Below is the Claim Status dropdown menu in ECLIPSE:
You will retrieve reports by clicking on the button to move your claim on from Submitted so that you can, in turn, move it along to Finalised. When you click on you may see the status update and the claim may move on to a different section of ECLIPSE.
Please note: Patient Claims sent via ECLIPSE do not have their reports returned through Genie. The reason for this is that the benefit for these is payable to the patient, so once you have sent the claim, the processing and payment information is between the patient and Medicare/the fund. You won't be able to retrieve reports for any claims with PC in the type column.
When a claim is submitted, the Report Status and Process Status columns in the IMC Claims Control window will be blank until you click the button.
In ECLIPSE you can retrieve the report and process status for all claims you see in the Submitted section of ECLIPSE by highlighting the claim at the top of the list, then holding the Shift key on your keyboard and clicking on the last claim to highlight all the claims you wish to select. Alternatively, hold Ctrl/Cmmd and the A key on your keyboard to highlight all at once. Next, select .
The appropriate action to take to progress these claims closer to finalised will be determined by the Report Status and Process Status columns returned from this process.
By retrieving the report status on a claim you can see where it is up to in its progress to finalised. For example, a claim that has only just been submitted may still be ‘MEDICARE_ASSESSING’. If this is the case, you would wait another day or a few days and click on again to see when the status has changed.
A claim submitted a day or two previously may be ‘HEALTH_FUND_ASSESSING’.
Sometimes, clicking on does not clear out the claims in the Awaiting Remittance Advice area. This is due to either the report having previously been retrieved and the claim is ‘stuck’ or Genie is having trouble locating the remittance advice. There are three things we can do to try moving these claims on:
- Check whether the claim has a Paid value. If the Paid value is filled in, the ERA has been successfully retrieved but there is something else preventing the claim moving to Ready to Receipt. Often, this is because Claimed and Paid don’t match. If that’s the case, click View Processing Report and balance the items.
- Hold down Alt and click on . Set the From and To dates initially to cover the claim period (claim date + 30 days) and check both Ready and Reported. Repeat this process until you reach today’s date.
- Check the date on the claim. While ERAs are usually available within 1-2 weeks, if the claim is less than 30 days old, you should wait for the full duration of the possible time period before becoming concerned. This is particularly true for smaller funds
If you have tried all of the above and the remittance advice is still not available, contact the health fund to request the following information:
- When the claim was paid
- The payment reference on the bank statement
- How much was paid in total in the payment
- What amount was paid for the claim
You can then cross reference this information with your banking and navigate to Billing > Receipt by Invoice Number to receipt this claim manually.