MBS Items Online Checker and patient care plan history search in HPOS 133-20111745

Health professionals and their delegates can use the MBS Items Online Checker to:

• view and check patient eligibility based on their MBS history
• check their own eligibility for claiming MBS items
• check the claiming conditions for MBS items

The MBS Items Online Checker advises if there is a claiming issue for the item selected. A Yes or No result displays. A No result also includes the reason for that result.

Note: the MBS Items Online Checker does not search Veterans' Affairs claiming history.

Only one item should be checked at a time. If there is a time dependency/restriction, the checker will not advise which items are restricting with the searched item.

The MBS Items Online Checker:

• function is similar to a pro-forma claim. If multiple items are entered, the checker will verify if they could all be paid together in one claim. This could give an incorrect result and the history may not be searched if the items restrict against each other
• returns a No result for claiming errors, for example, the health professional is not registered, age restrictions etc.

The MBS Items Online Checker information is provided under the following conditions:

• The response is based on information supplied by the health professional at the date the check is done
• Where a requested MBS item requires a valid referral, the MBS Items Online Checker assumes a valid referral is in place
• The result of the item check does not guarantee payment of a claim. Medicare assesses a claim based on the patient’s eligibility at the time of processing
• The information is subject to change if claims are pending
• The result of the MBS Items Online Checker is based on a patient’s claiming history and only indicates the benefits that may be payable at the date of enquiry

On the MBS Items Online Checker health professionals can:

• use Search item number to find a specific MBS item
• use Filter by care plan to filter items by care plan type. They can filter by Chronic disease management, Eating disorder treatment or Mental health treatment care plan type
• select the MBS item number they want to check and get a short description if they hover over an item number
• review the Selected items if checking multiple MBS items
• select Check Items to do the item check

The Resources page contains:

• links to the Services Australia website, and
• MBS Items Online Checker screenshots

The Training & Support page contains links to:

• eLearning
• simulations, and
• the Health Professional Education Resources website

Care plans:

• under Medicare coordinate patient care. For example, those with:
• chronic conditions
• mental health conditions
• eating disorders, or
• other health needs
• reduce the need for ad hoc consultations
• are useful for recording comprehensive, accurate and up-to-date information about a patient’s:
• condition, and
• treatment

Current care plan services give patients access to Medicare subsidised mental and allied health services to support their treatment.

Health professionals and delegates:

• using a Provider Digital Access (PRODA) account can view a patient’s care plan history for the last 12 months in HPOS. The claiming history is recorded against a patients Medicare record
• cannot access a patient’s clinical care or treatment plan in HPOS
• can use existing delegate processes to add a practice manager or practice staff member as a delegate in HPOS. As a delegate, they can find billing history for care plans to support patients, and health professionals when required

‘GP’ in plan types below is used to indicate general practice services provided by general practitioners and prescribed medical practitioners.

View patient care plan history displays history for the following care plans:

• GP Management Plans
• Team Care Arrangements
• Multidisciplinary Care Plans
• GP Mental Health Treatment Plans

To create, review or manage a care plan, health professionals and their delegates can view a patient’s care plan history to check:

• if there is a current plan in place
• eligibility for Medicare services

Patients can monitor access to their care plan history through their Medicare online account. Patients can report unauthorised activity to Services Australia.

The Resources page contains information on reporting health fraud.

A health professional or their delegate can only view a patient's care plan history if the patient:

• is enrolled in Medicare
• is over 18 years of age
• is registered for a Medicare online account, and
• has given verbal consent

The health professional must be registered with an individual Provider Digital Access (PRODA) account to access services in HPOS.

To view a patient's care plan history, health professionals must confirm the patient's details using:

• a Medicare card number
• the individual reference number, and
• first name

Health professionals can access the MBS Items Online Checker and patient care plan history in HPOS with an individual Provider Digital Access (PRODA) account.

Delegates can be nominated and given permission to access the:

• MBS Items Online Checker, and
• View Patient Care Plan History function within HPOS

See Health Professional Online Services for more information