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Patient Claims quality checking processing 111-22090020

This page contains a table outlining the daily procedures for patient claims quality checking.

Daily processes for patient claims quality checking

Note: if the Service Officer's batch has left the source office prior to quality checking, it must be recalled.

Step	Action
1	Select transactions to check + Read more ... Key QBBI and press [Enter]. The QBBI screen displays details of selected transactions to be quality checked. Note: for more information on how to interpret information on the QBBI screen, see the Quality Control System (QCS) for Medicare in Resources The details returned on the QBBI screen format for patient claims transactions include: PRC DT - processing date TIME - time of processing OPER - logon ID of the Service Officer who processed the transaction TY - transaction type - values are: CT - Credit EFTPOS (payee code 7) FT - EFT (payee code 9) QD - cheque to doctor via claimant (payee code 2) TRAN - transaction that was updated REFERENCE DETAILS - the Medicare card number selected for quality checking
2	Select transaction to be checked + Read more ... Select the transaction to be checked by positioning the cursor in the 'S' (select) field then pressing [Enter]. Medicare patient history screen displays the claims history of the transaction selected. To view the transaction timestamp for each item line, press [F9]. The timestamp on history must uniquely match the time of the selected transaction on QBBI.
3	Check transactions + Read more ... Manual Find the transaction source document, that is, hard copy/digital image Compare the source document(s) with the claim’s history displayed and determine if the patient claim was processed correctly Go to Step 4 Online Examine history to determine what Service Officer intervention has occurred Check PI codes, reason codes, rejections, and text messages to determine if the patient claim has been processed correctly If the intervention cannot be determined, update the transaction as error free
4	Code error + Read more ... Press [F3] to exit from history and return to the QBBI screen. Key the appropriate status codes in the Status fields for the selected transaction and press [Enter]. Note: only one status code must be keyed - the error with the greatest impact where no errors are detected, the appropriate status code is 001 The system returns a 'u' in the S (select) field to indicate that the selection has been updated. Note: if no status codes have been keyed, the system returns a 'b' to show that the selection has been browsed, but not finalised.
5	Exit QBBI + Read more ... When all transactions have been actioned press [F3] to exit the QBBI screen.
6	Paperwork + Read more ... Manual Endorse the source documents and batch envelope with: QC Quality Checker's signature date Note: do not write on the front of source documents. This ensures information is not obscured if required to be reviewed in the future.
7	Reporting errors + Read more ... Note: see Resources for links to the online Error Explanation Sheet and Guide to completing the online Error Explanation Sheet. For errors identified: Manual Return a copy of the claim with a brief description of the adjustment required: to the Service Officer for correction, or send to the appropriate section in the program for actioning Enter the error information on the online Error Explanation Sheet. Ensure all errors identified in the checks are recorded Online Print the patient claims history twice and endorse with a brief description of the adjustment required Return a copy of the prints to the Service Officer for correction or send to the appropriate section in the program for actioning Complete and submit the online Error Explanation Sheet. Ensure all errors identified in the checks are recorded See also The Quality Control System (QCS) for Medicare in Resources.