This document details how to process radiation oncology claims in a timely and efficient manner to make sure national consistency is maintained.
From 1 July 2024
On this page:
Process claims for multiple sites
Process claims for multiple sites
Note: if the account/invoice has:
only one item and is over $9,999.99, see the relevant table in Charges $10,000 or more (greater than $9,999.99) for Medicare patient claimsout-patient items both over and under $9,999.99, see Table 6 in Charges $10,000 or more (greater than $9,999.99) for Medicare patient claimsTable 1: describes how to pay a radiation oncology claim with multiple planning or treatment sites with a date of service from 1 July 2024.
Expand tableStep | Action |
1 | Check date of service
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: |
2 | Start processing claim
For: |
3 | Identify sites
Identify: - the first planning or treatment item
- each additional anatomical site
Note: this information is populated by the health professional for online claims. The Resources page has a list of items. |
4 | Read claim text and/or supporting information
Read any text or annotation provided by the health professional to confirm each anatomical site being claimed. |
5 | Assess claim
Check and read 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. |
6 | Finalise claim
- Press Enter
- Key P to pay claim
|
Before 1 July 2024
On this page:
Process accounts/invoices
Key the amount charged from the account/invoice
Process accounts/invoices
Note: if an individual charge is over $9,999.99, see the relevant table in Charges $10,000 or more (greater than $9,999.99) for Medicare patient claims.
Table 1: describes how to pay a radiation oncology claim with 2 or more fields for accounts/invoices with a date of service before 1 July 2024.
Expand tableStep | Action |
1 | Check date of service
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: |
2 | Identify fields
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. |
3 | Key details
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: |
4 | Key LSPN and equipment number
- 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. |
5 | Return messages
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. |
Key the amount charged from the account/invoice
Table 2: lists the actions taken to record the amount charged.
Expand tableStep | Action |
1 | Identify charge type
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
|
2 | Single amount charged for each item
Key each amount in the charge field against each item. |
3 | One amount charged for combined single field base item and matching additional field derived fee 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. |
4 | One amount charged for the combination of all items on the account/invoice
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
|
Expand all