Bulk Bill quality checking processing 111-22090010

Services Australia uses digitally enabled processing (DEP) to create a PaNDA work item ready for allocation.

To receive a new work item for quality checking in Work Optimiser Worklist, Quality Checker to select the Ready button once.

For more information, see Work Optimiser for staff.

When selecting a PaNDA work item from Worklist, staff are automatically redirected to the Work Item and Document Details screen.

To open documents associated with the work item:

• Select the Document ID line to view the document image
• A new window will open and display the document in a tabular format
• Information on the right of the table will have the details from Quality Control System (QCS) QBBI needed for checking the work

When staff receive their own work item for checking:

• add a processing note to the PaNDA record 'own work' and select Save
• use the HSDD Local Peer Support - SO4's Microsoft team's chat, seek QC support from a Service Officer (SO4) on processing duties to have their work checked:
• SO4 available:
  • Yes - reassign the work item to that staff member using reason code 'Service Support Referral'
  • No - email it to Workload Management Health to reassign the work item. Key 'QBBI QC' in the subject line and the PaNDA work item detail in the body of the email

When staff do not have the skills to check the work item:

• add a processing note to the PaNDA record 'not trained in worktype' (e.g.: 'not trained in BBADJ) and select Save
• click 'unassign' and select reason 'Capability adjusted' in PaNDA. See Table 2 > Step 7 in Work Optimiser for staff
• add skill and then select relevant details. Check the Capability adjustment Worktype table

Log into Medicare Mainframe (CICS) using the Source Office Code (SOC) included in the PaNDA document for completing the quality check.

• Key 'QBBI,ST/ALL,DOP,OPER/NO' and press [Enter]
  e.g.: QBBI,ST/ALL,DDMMYY,OPER/nnnnn
  Note: key the processing staff logon number without the 'P' letter prefix
• The QBBI screen displays details of selected transactions
• Compare the details in the PaNDA document
• Locate the QBBI line for quality checking. Note: QBBI screen may display with a list of transactions for the OPERNO. Compare and quality check the Medicare card number only listed in the PaNDA document

The details returned on the QBBI screen format for bulk bill transactions include:

• PRCDT - processing date
• TIME - time of processing
• OPER - operator number of the Service Officer who processed the voucher
• TY - transaction type - values are:
  • BM - bulk bill manual system paid
  • BN - bulk bill manual Service Officer paid
  • BI - bulk bill HIC online Service Officer paid
• TRAN - transaction that was updated (DAPI/C/U)
• REFERENCE DETAILS:
  • card number or provider number for the voucher selected
  • claim id of the claim in which the voucher will be found

A transaction is selected based on the time the bulk bill claim was processed and the voucher number. The voucher number on QBBI will not always match the voucher number on the patient's history screen.

The voucher number on QBBI is the 'index' number of where the voucher is positioned within the claim by the overnight file.

Note: for more information on how to interpret information on the QBBI screen, see the Quality Control System (QCS) for Medicare in Resources.

Select the transaction to be checked by keying 'S' in the Selection column then press [Enter].

The Medicare patient history screen displays the claims history of the voucher selected.

For:

• vouchers of bulk bill claims, go to Step 5
• online transactions, go to Step 6

For vouchers of bulk bill claims:

• examine the batch of the Service Officer who finalised the claim and locate the source documents
• compare the source documents with the claim's history displayed and determine if the voucher has been processed correctly

Note: it is necessary to check that the claim header (DB1) and vouchers for the claim have been completed correctly.

Go to Step 7.

For online transactions:

• key DQRI,provider number,Claim ID
• key 'F' against the claim to be selected
• check the raw data to see if the information transmitted is the same as the patient history
• read text, (indicated by a T in the service line on the history screen), in conjunction with processing indicators and reason codes on the history to determine if the claim has been assessed appropriately

Note: if the Service Officer is unable to determine if the claim has been assessed appropriately, they should follow the appropriate escalation process for the relevant program.

See also the Explanation of DQRI online formatted data for bulk bill claims attachment on the Resources page.

After examining the transaction and source documents, return to the QCS.

Press [F3] to exit from history and return to the QBBI screen.

QCS shows b (browse) in the S field and is now ready to accept status codes in the STATUS field to indicate whether the transaction has been processed correctly or incorrectly. See Resources for status codes.

Key the appropriate status codes in the Status fields for the selected voucher and press [Enter].

Where no errors are detected, in the STATUS field record the status code as 001.

Where errors are identified in the STATUS field for the transaction selected, key all status codes (critical and non-critical) and press [ENTER]. Where more than 4 errors are found refer to error status D39.

The system returns a u in the S (select) field to indicate that the selection has been updated with a status code.

Note: if no status codes have been keyed, the system returns a b to indicate that the selection has been browsed, but not finalised.

Each time a quality check is completed, the quality checker must:

• email the Service Officer and their Team Leader advising the quality check outcome
• give feedback with a brief description of the action required by the Service Officer for correction
• use the relevant QBBI quality checking email template for sending emails. The Resources page contains these templates

Press [F3] to exit the QBBI screen.

On completion of quality checking, update the status to Complete on the Work Item and Document Details screen:

• select Complete in the Status field
• select Save

A message will display at the bottom of the screen advising that the work item has been successfully saved.

It may take several minutes for the work item to disappear from the Worklist.