Processing radiation oncology 011-43010150

From 1 July 2024, separate processes apply when processing radiation oncology claims depending on the date of service. Service Officers must follow the process relevant to the date of service they are processing.

If the date of service is:

• before 1 July 2024, see Table 1, Step 1 on the Before 1 July 2024 tab
• from 1 July 2024, go to Step 2

Identify:

• the first anatomical site item (15952) on the account/invoice
• each additional anatomical sites (15954) on the account/invoice

Note: this information is populated by the health professional for online claims.

The Resources page has a list of items.

Key the details for:

• the first anatomical site item, and
• each additional anatomical site items on subsequent lines. The maximum number of additional sites that can be claimed is 10

• In the Fee field, key the Location Specific Practice Number (LSPN) and equipment number
• Preceding zeros are not required for the LSPN. For example, key L0125 as L125

Note: this information will be populated by the health professional for online claims.

Check all return messages in full:

• press [F1] to display multiple pages and actions where necessary
• press [F1] again to display multiple pages and actions in each return message

The Resources page includes radiation oncology return messages and resolutions.

Check the amount charged on the account/invoice:

• Single amount charged for each item, go to Step 2
• One amount charged for combined single field base item and matching additional field derived fee item, go to Step 3
• One amount charged for the combination of all items on the account/invoice, go to Step 4

Key each amount in the charge field against each item.

Key:

• the amount charged against the first anatomical site item, and
• zero in the charge field for each additional anatomical site treatment item/s

The Resources page has a list of items.

Key:

• the amount charged against the first anatomical site item as a notional charge, and
• zero in the charge field for all remaining items

From 1 July 2024, separate processes apply when processing radiation oncology claims depending on the date of service. Service Officers must follow the process relevant to the date of service they are processing.

If the date of service is:

• before 1 July 2024, go to Step 2
• from 1 July 2024, see Table 1, Step 1 in the From 1 July 2024 tab

Identify the:

• single field base item on the account/invoice
• matching additional field derived fee item
• number of additional fields on the account/invoice/text for the additional field derived fee item

Note: this information is populated by the health professional for online claims.

The Resources page has a list of items.

Key the:

• details for the first single field base item, and
• details for the matching additional field derived fee item on the next line, then
• number of additional fields in the NO field for the additional field derived fee item. The maximum number of additional fields is 5

Note: Service Officers must key multiple treatments on the same day, in separate claims.

Manual claims

Service Officers must key a:

• separate claim for all base items that have a correlating derived fee item
• new claim for each individual combination of base and derived fee items

Electronic claims

For electronic claims, the first base and derived fee items must be paid, and subsequent items rejected. See the Resources page for the rejection codes. Health professionals must resubmit a separate claim.

Repeat this step for the remainder of items.

For:

• manual claims, go to Step 3
• online claims, go to Step 4

• In the Fee field, key the Location Specific Practice Number (LSPN) and equipment number
• Preceding zeros are not required for the LSPN. For example, key L0125 as L125

Note: this information will be populated by the health professional for online claims.

Check all return messages in full:

• press [F1] to display multiple pages and actions where necessary
• press [F1] again to display multiple pages and actions in each return message

The Resources page includes radiotherapy return messages and resolutions.

Check the amount charged on the account/invoice:

• Single amount charged for each item, go to Step 2
• One amount charged for combined single field base item and matching additional field derived fee item, go to Step 3
• One amount charged for the combination of all items on the account/invoice, go to Step 4

Key each amount in the charge field against each item.

Key:

• the amount charged against the single field base item, and
• zero in the charge field for the additional field derived fee item

The Resources page has a list of items.

Key:

• the amount charged against the first single field base item as a notional charge, and
• zero in the charge field for all remaining items