Are you having to manually send patient claims to Medicare on behalf of your patients? Genie has an inbuilt function that allows you to send off patient claims through our software, making your invoicing and claiming that much easier.
Online Patient Claiming works in two ways:
- Now (Real-Time); and
- Later (Batch).
In real-time, the patient claim is created and transmitted to Medicare at the time the invoice or receipt is generated.
In batched mode, the claims are batched and transmitted later whenever convenient. Batched mode is similar to the way in which Bulk Bill and DVA claiming works.
Before you begin
To send patient claims electronically, each doctor wanting to use this feature must be registered for HIC Online. The HIC Online software must also be installed on each computer wanting to send the claims. Please see our article on Setting up HIC Online for further instructions.
To send patient claims in real-time, ensure that the Use Real-Time by Default checkbox is ticked in File > Practice Preferences > Miscellaneous. If you are wanting to send your patient claims in batches, leave this checkbox unticked.
In the Invoice window , the following checkbox will be displayed when invoicing a patient whose Account Holder is listed as Self.
The Use Patient Claims checkbox indicates whether a patient claim should be created for the current invoice. The drop-down menu allows default values to be set for the current Account Holder as below.
|Ask Me||The Use Patient Claims checkbox is available, but defaults to being not ticked.|
|Always||The Use Patient Claims checkbox is available, and defaults to being ticked.|
|Never||The Use Patient Claims checkbox is not ticked and unable to be ticked.|
You can also set this directly in the patient's Account Holder record by navigating to Open > Account Holders and choosing one of the above options in the Use Patient Claims drop-down.
The same override flags used with Bulk Bill and DVA invoicing are available when adding an item to an invoice using Patient Claims.
No Payment/Gap Paid by Patient
If no payment amount is entered for the invoice, when the Print button is clicked in the Invoice window, the Create Patient Claim window is displayed.
This window provides the following options:
- Transmit this Claim - This allows you to choose whether the claim is to be sent in Real-Time mode or Batched mode. If the Use Real-Time by Default checkbox is ticked in Practice Preferences, the Now radio button will be selected, otherwise the Later radio button will be selected.
- Send Payment To - This allows you to choose whether the cheque will be sent to the patient's address held by Medicare, or to another specified address. This cannot be a PO Box or the practice's address.
Patient Paid Full Amount
If a payment amount is entered for the invoice, when the Receipt button is clicked, the Receipt window is brought up as usual, along with the Patient Claims area displayed in the Invoice window. The patient claim option can be changed here if required. When the Print button is clicked, the Create Patient Claim window is displayed.
When a claim has been paid in full, the additional options are available in this window:
- Payment Method - to indicate whether the patient's benefit should be paid by Cheque or EFT. This value is saved in the Account Holder's record, therefore the default value for the current account holder will automatically be selected.
- Never Store Bank Details - if you choose EFT, this checkbox indicates that the account holder's bank account details should never be stored in the Genie database. If they are stored, they will automatically be filled in for each Patient Claim for this account holder. If the checkbox is ticked, the user is never prompted to save the bank account details when they have been entered.
- Bank Account Details - if you choose EFT, the account holder's bank account details must be supplied. If the details have previously been saved with the account holder, they will automatically be filled in.
Note: If the patient has registered their bank details with Medicare, then selecting 'Cheque' will mean the money will be deposited to their account and no bank details need to be entered into Genie.
Clicking the OK button results in a dialogue box stating 'Building Patient Claim...' Once this disappears, the patient claim has been created.
For batched claims, a lodgement advice will be printed and the invoice/receipting process is now complete. For real-time claims, once the claim has been created, it is automatically submitted to the HIC. While this process is occurring, a dialogue will appear stating 'Submitting Claim...' Once this disappears, the patient claim has been created.
If the claim is successful, either a Statement of Claim and Benefit Payment or a Lodgement Advice is printed out, depending on whether or not the invoice has been paid.
Please note: If you submit a patient claim without a payment against it, and then later receipt it, it will still appear as unpaid on the Statement of Claim.
If the claim is unsuccessful, the Patient Claim Errors window will be displayed.
This window lists all of the services which have generated errors. Clicking on a service will display the corresponding error message in red.
Depending on the nature of the error, it may be appropriate to edit the Item, Patient, Claimant, or Provider details. Buttons are provided on this window to take you directly to the entity in question. If it is simply a matter of the patient or claimant's Medicare number or Individual Reference number being incorrect, these can be easily updated to the values held by the HIC by clicking on the Update Patient or Update Claimant buttons.
Some errors may not be serious enough to cause the claim to be rejected. These errors have a Y in the Acceptable column. If all of the errors are acceptable, the Accept button will be enabled. Clicking the Accept button will send the claim to the HIC for manual processing.
If all of the errors which have an N in the Acceptable column have been dealt with by editing the Item, Patient, Claimant or Provider details, the entire claim can be resubmitted by clicking the Resubmit button.
Patient Claims created using the batched method must be batched and transmitted to the HIC. This functionality is accessed within the Patient Claims Transmission button in File > Maintenance & Reports > Daily tab.
Clicking this button takes you to the Patient Claims Control window. To create a new transmission, click on the New Transmission button.
This window lists all batched patient claims which have not yet been batched and submitted to Medicare. If necessary, you can remove claims from the current transmission by checking the Hold checkbox beside the claim.
When you are happy with the claims to be transmitted, click on the Create Transmission button. This will batch up to 30 of the displayed claims into a single transmission. When the transmission has been created, the Transmit button will be enabled at the bottom of the window and the message 'Transmission created successfully' will appear above it in blue.
Clicking the Transmit button will send the claim to Medicare for processing and will return you to the Patient Claims Control window.
A Patient Claim can be created after an invoice or receipt has already been generated. This is achieved in the patient's Account History window (Billing > Account History). There are two buttons in this window: Create Patient Claim and Delete Patient Claim.
Creating Patient Claims
To create a new patient claim, select the item(s) that you would like to include in the claim, and click on the Create Patient Claim button. This will open the Create Patient Claim window and allow you to proceed as you would during the invoice or receipting process as explained in the sections above.
Deleting Patient Claims
In some instances, Patient Claims are created in error or need to be adjusted after they have been created. For more information on how and when you can delete a patient claim, please see our Deleting Patient Claims article.
Note: This function can only be used on claims on the same day they were created.
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