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Medicare Claim History Report


The Medicare Claim History report displays any claims that have been submitted to Medicare via any Patient, DVA or Bulk Bill claiming.
Medicare Claim History Report
1

Select a date range

1. Select a date range
Enter the date range to find claims for
Clicking on Selected Range enables the From and To date fields
2

Get Data

2. Get Data
Click Get Data to search for claims for the date range above
3

Check Status

3. Check Status
Check to check the status of all claims. Use this to find out if a claim has been paid or not.
 
Status - whether the claim is: NEW, INVALID.....
  • NEW - The initial status for all claims.
  • WITH MEDICARE -  status for DVA, Bulk Bill, once submitted. Note, if a claim stays at With Medicare for more than a week, it can be worth calling Medicare to find out why there is an issue with the claim. Because the claim is with Medicare and has stalled there is no information that we can pass back in an automated manner.
  • INVALID - there is a problem with the claim at time of submission. There is usually a message that pops up for the user at submission time so that they can review and fix the data and resubmit the claim. See the message field for details of what the issue is.
  • PROCESSED - If an organisation will be paying a benefit it sits at processed until it is paid
  • COMPLETE - When a claim has been paid. If the benefit various organisations will pay for the claim all =  $0, the claim will be marked as COMPLETE and no more information is expected
  • DELAYED - There is some other error with the claim, for example: error 9201 – Invalid format for data item. This is an error indicating that the pre-processing has found an error in the format of some element(s) in the claim. E.g with the format of the client's name.
  • REJECTED - This means claim was rejected by Medicare (“benefitPaid”: 0) with assessment error code based on the standard medicare rejection codes (link below)
  • LOST - when we successfully submitted the claim to Medicare but there was no response after 14 days we change the status to LOST. There’s nothing at Medicare for us to retrieve and report on. Almost always this means the provider paperwork is not submitted or not yet processed.
 
Please refer to the Human Services website here for information on common Medicare Rejection Codes and here for details on all reason codes.
 
For DVA rejection reason codes information please click here.
4

Process Flow

4. Process Flow
Pending – shows claims that have been sent to Medicare but not yet paid. The most recent claims are displayed at the top.
Failed – shows any claims that have been Delayed, Rejected or Lost. Claims are able to be resubmitted from this screen.
Complete – shows all completed claims
All – shows all claims
+ - Can be clicked to include any claims that failed to be sent to Medicare because they were rejected at the time of submission. These display within the ALL tab only.
 
5

Find a claim

5. Find a claim
Use the Find field to search for a particular word within the report, i.e. to find a particular item
6

Group by....

6. Group by....
Use the Group By option to group the claims entered. An example would be to drag the Claim Type field upto the Group By header so that the claims can be displayed by type.
 
7

Search Results for date range

7. Search Results for date range
Search results for the above date range.
 
Fields available:
Timestamp - date and time the claim was sent
Claim Type - whether its Bulk Bill, VAA (DVA), Medicare (Patient Claim)
Client - who the claim is for
Invoice No. - Invoice claimed
Invoice Item - Item description
Item Code - Medicare or DVA Item Code
Claim Amount - Amount claimed
Charge Amount - Amount charged. For DVA and BB this must be the same as Claim Amount
Appointment - Appointment Date and Time
Claim ID - Claim ID assigned by Bp Allied
Message - any error messages relating to the claim will be stored here. If it has been successfully sent then the message is "Claim queued for sending"
Transaction ID - ID assigned by Claiming.com.au
Servicing Provider ID - The provider number of the medical practitioner rendering the service(s) as allocated by Medicare
Referring Provider ID - The referring provider number
Referral Date - The date the referral was issued
Last Status Check - date and time when the status was last checked
Check Status - Click to check the status if an individual claim
Assessment Note - Includes any rejection codes that come back from Medicare if the claim could not be successfully processed
Benefit Paid -  amount paid by Medicare or DVA. This could include Loading and KM payments
Status – as above, the current status of the claim
Benefit Assessor – whether the claim has been assessed by Medicare or DVA
Assessment Note Code – Code returned from Medicare or DVA if the claim has been failed
Assessment Note Assessor – ID of the person that has assessed the claim at Medicare
Payment Run – payment batch number from Medicare
Practitioner – Practitioner assigned to the invoice that was claimed.
Notes – notes can be added if claim needs to be resubmitted
Resubmitted – checkbox is ticked if the claim has been resubmitted
Resubmitted date – the date resubmitted (if relevant)
Payment No – link to the payment record
Link to Record – links to original claim if this claim was one that was resubmitted
 
8

Print

8. Print
Print the results
9

Output to Excel

9. Output to Excel
Export the results to Excel
10

Cancel

10. Cancel
Close the report
11

Reset to default

11. Reset to default
Used to reset the columns under each tab to the default layout