Bulk Bill and DVA Online Claiming

Using HIC online to transmit your Bulk Bill and DVA claims adds just a few extra steps onto your normal invoicing processes. To create the claim, you will need to first create your invoice as normal. If applicable, you will also need to complete some of the additional fields at the bottom of the window upon adding the item(s):

• Restrictive Over-rides are standard over-ride flags to be sent as part of the claim. Only the tick-boxes applicable to the current billing scenario will be visible.
• Reason for No Referral will appear if the provider is marked as a specialist in their User Preferences and the patient does not have a valid referral. In this scenario, extra radio buttons will be displayed. These radio buttons are used to provide a reason for treating the patient without a valid referral.
• You can also use the Note box at the bottom of the window to add in any additional information (i.e. Service Text). Claims with service text will not be automatically processed. It will be referred to an operator for manual intervention.

After the invoice has been created, the settings made to these override flags can be altered in the Edit Sale window. This window is accessible by double-clicking on a displayed Sale (i.e. service) in either the Account History, Receipt window, or from within the claim.

Once you've created some bulk bill and/or DVA invoices, you can transmit the claims electronically as a part of a batch.

1. Go to File > Maintenance and Reports click on the Daily tab. Select the Bulk Bill/ DVA Transmission. This will present you with the Medicare Claims Control window.

2. To create a new HIC Online transmission, click New Transmission at the top left-hand corner of the Medicare Claims Control. This will bring up the New HIC Online Transmission window.

3. Make a selection from the Provider drop-down. Separate claims need to be created for each provider. If the provider has more than one provider number (i.e. they work from multiple locations), you will need to submit the claims for each provider number separately by making the relevant selection from the Provider No drop-down.

4. Using the radio buttons, you will need to select whether you wish to send Medicare claims or DVA claims, as well as Inpatient or Outpatient.

5. Once you've made all the appropriate selections, the New Transmission window should list all of the relevant services - that is, all unpaid services for the relevant provider number where the Account Holder is Medicare or DVA, and where those services are inpatient or outpatient.

6. To remove a sale from the displayed list, highlight the service(s) and click the Remove Highlighted button. Alternatively, if it makes more sense to select the service(s) you want to keep, highlight those items and click the Keep Highlighted button. Removed sales will  be included in your subsequent batch if they still have a balance.

7. When you are happy with the list of claims showing in the window, select Create Transmission. The message to be sent to Medicare will be generated and show in the Message box at the bottom of the window.

8. After the transmission message has been created, the Transmit button at the bottom of the window will become enabled. To send off the transmission, please select this Transmit button.

Once a claim has been transmitted, it will be in the Awaiting Reports section of the Claims Control. All claims in the Claims Control will be in one of four states:

• Awaiting Reports: The claim has been submitted to Medicare, however, the payment and exception reports have not been received.
• Exceptions to Review: One or more exceptions have been identified by Medicare; these must be dealt with before further processing of the claim is allowed.
• Ready to Receipt: The payment report has been received and there are no outstanding exceptions for the claim. The payment can now be receipted and the claim can be finalised.
• Finalised: The claim has been fully receipted.

Claims in each stage can be displayed by making a selection from the Show drop-down.

After being processed, two reports are produced for each claim:

• A Payment Report, which provides the Date Paid, the Run Number and the Amount Paid; and
• An Exception Report, which deals with any problems Medicare has identified with the claim.

The process of retrieving reports is as follows: 

1. Select Awaiting Reports from the Show drop-down to display all claims that do not yet have a payment and/or exception report.
2. Select the claim(s) you would like to retrieve reports for by highlighting them in the list (additional claims can be selected by Shift+clicking or Ctrl+clicking on them). If you're having trouble trying to retrieve reports for multiple claims at once, try only highlighting a maximum of five claims.
3. Click the Retrieve Reports button.

Once the reports have been retrieved, the claim will be moved to either the Exceptions to Review list or, if the claim did not have any exceptions, the Ready to Receipt list. The Payment Report will fill in the Date Paid, Run No, and Paid columns on the Medicare Claims Control Window. The Exception Report will fill in the Exceptions column on the Medicare Claims Control window, i.e. change it from 'N/A' to a number.

It's worth noting that, when retrieving reports, it's common for several claims to be paid with the one Payment Report. Therefore, claims that you have not selected may have their Payment Reports returned when retrieving reports for a different claim.The same is not true for Exception Reports, i.e. only the Exception Reports for those claims you have selected when you click on the Retrieve Reports button will be returned. The result of this phenomenon is that you will likely end up with claims which have Payment Reports but do not have Exception Reports. These claims will remain in the Awaiting Reports list until their Exception Reports are retrieved.

Exceptions are Medicare's way of letting you know that there's a problem with the claim. A claim will only move into the Ready to Receipt area when all exceptions have been dealt with and deleted.

The number of exceptions for a claim is listed in the Exceptions column of the Medicare Claims Control window. If the number is 0, the claim has no exceptions. If the number is replaced with N/A, either the Exception Report has not yet been retrieved from the HIC, or it has been deleted for some reason. In either case, the Exception Report should be retrieved by clicking Retrieve Reports before proceeding.

To review exceptions:

1. Select Exceptions to Review from the Show drop-down list on the Medicare Claims Control window to list all claims with exceptions.
2. Highlight a claim in the list to view its exceptions; these exceptions must be dealt with one at a time.
3. Click on the Review Exceptions button to open the Claim Exceptions window. If this button is greyed out, it means that either the claim did not have any exceptions (the Exceptions column will contain 0), the Exception Report has been deleted (the Exceptions column will contain N/A), or that the Exception Report has not yet been retrieved (the Exceptions column will contain N/A).
4. Highlight each exception one by one to display more information about the exception. To assist in dealing with the exceptions, a report of all exceptions in the claim can be produced by clicking the Print button.
5. Determine whether the account has been paid by comparing the Claimed and Paid columns.

   • If the claim has been paid

     Sometimes you will receive an exception for an item that has been fully paid. This is usually due to a minor issue like an incorrect claim amount or an incorrect Medicare number. It is important that you still rectify this issue; ignoring it could mean the patient's next claim will be rejected.

     If there is a problem with the item, click on the Edit Item button to open it in the Sales window. Press the Edit button and rectify the issue. For example, if Medicare has paid a few cents more or less than you claimed, you would need to adjust the Charge Amount accordingly.

     If there is a problem with the patient’s details, click on the Edit Patient button to open the Patient Demographics window. Alter the incorrect details to match Medicare's records and ensure you Save out of the record. If you've have checked the Medicare number in the Patient Demographics window and it is still listed as incorrect, you may need to check the Medicare number in the account holder record. This can be accessed by going into Open > Account Holders and searching for the patient (or their relevant account holder).

     Once you have fixed the problem, click on the Delete Exception button.

   • If the claim hasn't been paid and you plan to resubmit the item

     When a claim is completely rejected, this will usually indicate a bigger problem - for example, the claim may already have been paid or there may be a problem with the validity of the referral. In this instance, you'll need to resubmit the claim.

     You'll first need to address the problem using either the Edit Item or Edit Patient button. Once you've resolved the issue, click Remove Item From Batch and, as per the on-screen message, the service will be included in your next transmission.

     Once you've removed the item, click Delete Exception. 

   • If the claim hasn't been paid and you don't plan to resubmit the item

     If you don't plan to re-transmit an item, there's no point making adjustments to the item/patient. You'll simply need to take note of the patient and then click Remove Item From Batch. Once the item has been removed, click Delete Exception.

     Before you create your next transmission, you'll need to address the problem that caused the exception, otherwise the service will be included in your next batch.

     Open the patient's Account History (Billing > Account History) with the patient highlighted in the Appointment Book or Patient List) and deal with the problem item. There is no "right" or "wrong" solution, and how you choose to deal with the item will probably depend on the standard procedures in your practice. For example, you may choose to apply a credit to the item or you might choose to delete the item entirely. In some circumstances, you might decide to reissue the invoice to the patient as a private account. Whatever the solution is, it's important you deal with the item before you create your next Bulk Bill/DVA transmission.

6. Once you've dealt with all the exceptions and the list is empty, click on the Close button at the bottom of the window to return to the Medicare Claims Control window. The claim should move from Exceptions to Review to Ready to Receipt.

1. Select Ready to Receipt from the Show drop-down list in the Medicare Claims Control window to list all claims that have payment reports and no outstanding exceptions.

   Note: The amounts listed in the Claimed and Paid columns for each claim in the Ready To Receipt section MUST be equal. If they are not, you haven't dealt with the exceptions correctly. Click Retrieve Reports again and work through your exceptions again.

2. Click on the Receipt button. If this button is greyed out, it means that the claim has outstanding exceptions (check the Exceptions column in the list to make sure it is 0).

3. In the Receipting window, double-check that the amount you are receipting matches the amount that was actually paid by Medicare.

4. Once a claim has been fully receipted, it is automatically finalised. Finalised claims can be viewed by selecting Finalised from the Show drop-down list.

If Medicare or the DVA have paid a batch (in full or part) manually, ie. sent you a paper statement of payment rather than an online report, these can still be receipted by clicking the Receipt button. You will get an alert stating that there has not yet been a payment report received, or that the claimed amount does not match the paid amount as there may still be outstanding exceptions; you can select OK when asked if you would still like to receipt, and proceed to the receipt window where you can receipt the claim as appropriate.