Medicare claims and eligibility quality checking 111-22090000

This document outlines the Quality Checking procedures for Medicare bulk billing, patient claims and public eligibility.

Services Australia:

• administers Medicare on behalf of the Department of Health and Aged Care, which is responsible for developing Medicare policy
• pays Medicare benefits in accordance with legislation governing Medicare and has no discretion to pay benefits outside of this legislation

The Quality Checking process:

• is designed to ensure Services Australia is correctly assessing Medicare patient and bulk bill claims and public eligibility transactions
• checks information on source documents against information:
• entered into the Customer Information Control System (CICS) Mainframe and the Consumer Directory Maintenance System (CDMS),
• using the Medicare Quality Control System, also known as QBBI

Contents

Bulk Bill quality checking processing

Patient Claims quality checking processing

Public Eligibility quality checking processing