Sometimes, despite your best efforts, ECLIPSE claims can be sent with the wrong information. It's tempting to just delete them and start again, but these claims are like emails - Medicare receives them as soon as they're sent, and deleting them won't remove them from Medicare's servers. You may end up being paid for a claim you've deleted in Genie.
This guide explains what you need to do to cancel the claim before fixing it and sending it off again.
If you realise you’ve submitted a claim incorrectly, start by checking who is currently processing it (Medicare or the fund) as this will indicate who to contact. This is particularly important if the claim was sent more than a few hours ago.
To do this:
- Go to File > Maintenance and Reports > Daily tab.
- Click on ‘ECLIPSE IMC Transmission’ to open the IMC Claims Control window.
- Highlight the claim in the list.
- Click ‘Get Report Status’.
If the process status is ‘MEDICARE_ASSESSING’, call Medicare to cancel the claim.
If the process status is ‘HEALTH_FUND_ASSESSING’, call the fund as Medicare has already forwarded the claim to them.
Depending on the advice from Medicare or the fund, you will need to either delete the claim now or wait until the claim is rejected. Alternatively, if they were able to edit the claim details on their servers, you may be advised to just edit the invoice in Genie without resubmitting.
Note: as the claims are sent through an automated system, sometimes they cannot be changed from Medicare or the health fund's side after they have been submitted. In these cases, you should be guided by the advice from Medicare/the fund in each case for how to make the correct adjustment. This could differ from claim to claim depending on the scenario, type of claim, type of error and which fund is receiving the claim.
If you are advised to delete the claim, you can do this through the IMC Claims Control window by right clicking on the claim and choosing 'Delete'. If Genie asks for a password, you will need to call Genie Support to obtain this.
When you receive the prompt ‘Are you sure you want to delete this claim?', choose 'Delete'.
Genie will then ask what you would like to do with the invoice:
it is up to you which option you choose. However, in general, if the error on the claim is easily corrected (e.g. wrong referral, fees or site of service), you would choose to ‘Keep’ the invoice. For other errors such as charging the wrong item number, it may be easier to ‘Delete’ the invoice and start again.
If a claim gets paid after you have deleted it, and need to find the original information on the claim, the claim should still be sitting in the Deleted section of your ECLIPSE window.
Note: if it is a Known Gap claim and you have already applied the patient’s payment to the invoice, you will need to delete the payment through their account history before you will be able to delete the invoice. If the banking containing this payment has been sealed, you will need to use your dummy bank account when re-receipting the payment. If you are unsure of how to do this, please contact Support.
If you kept the invoice in Step 3, open it through the patient’s account history (Billing > Account History) and make the appropriate changes so it reflects the correct information. You can then resubmit it as follows:
- In the Account History window, highlight the invoice on the left.
- On the right, highlight the items you would like to resubmit by Ctrl/Cmd + clicking on each item. Or, to resubmit all items, highlight the first item then press Ctrl/Cmd + A on your keyboard.
- Click ‘Resend IMC Exceptions’.
- In the window that opens, check the details look correct.
- Click ‘Transmit’ to re-transmit the claim.
Alternatively, if you chose to delete the invoice when you deleted the claim, you can recreate it from scratch through Billing > IMC Invoice Wizard.