Bulk bill claims in Medicare 011-43030000

Note: proceed only if the caller meets the security check.

See Perform telephone security check for Medicare health professionals.

Request from caller:

• payee provider number
• claim ID

Key ‘DCEI,PAYEE PROVIDER NO, CLAIM ID’, for example DCEI,123456AB,A0001@

Press [Enter]

Note: Claim IDs with the following suffixes indicate:

• @ Medicare Online
• $ Medicare Easy claim
• + Medicare web claim via HPOS

The DCEI will show:

• the status of a single claim
• if the claim has been received/not received (The return message 1-CLAIM ID will show if not received)
• if the claim has been pended
• if the claim has been rejected
• if the claim has been paid
• if the date of lodgement is not known, the DCEI control line will reveal the date

• Key DPSI,PROVIDER NO,CLAIM ID,DOL=ddmmyy, for example DPSI,123456AB,A0001@,DOL=271114
• Press [Enter]
  Note: should the health professional request a duplicate statement:
• Key DPSI,PROVIDER NO, CLAIM ID,DOL=ddmmyy,R, for example DPSI,123456AB,A0001@,DOL=271114,R
• Press [Enter]

The Duplicate Provider Statement (DPSI) screen will show.

All patients bulk billed under the specific claim ID can be viewed.

The information will show:

• payee and service health professional details
• claim ID number
• patients name and Medicare number
• date of service
• item number(s)
• assigned benefit
• benefit paid
• Reason code (if there is a discrepancy between the assigned benefit and amount paid)

Note: for any bulk bill claims that have been processed under source office code AJSI, AJSS, AJSC or AKJB and the health professional is disputing any information processed. Service Officers are to email a snip of the mainframe screen, the enquiry and include the caller’s name and contact details to Provider Services for actioning.

See also: Requests for provider statements for eBusiness/eServices for more details about viewing and requesting bulk bill statements.

Note: proceed only if the caller meets the security check.

See Perform telephone security check for Medicare health professionals.

Request from the caller:

• patient’s Medicare number
• patient’s full name and date of birth

• Key NHSI,MEDICARE NUMBER
• Press [Enter]
• Select the patient

• Date of service
• Item number

Search for the service on the patients history:

• use [F7] and [F8] to search history

When the service is located:

• place curser under the 3 digit reason code in the RSN field
• press [F1]

Note: modifiers can be used to shortcut to specific information.

Tell health professional about the reason for rejection.

Note: in some cases, claim rejections require further investigation due to:

• item number restrictions (Reason codes 179 or 159)
• item number time dependencies (Reason code 160)
• associated item number not claimed (Reason code 550)
• duplicate services (Reason code 162)
• patient eligibility (Reason code 211)
• expired Medicare card number (Reason code 320 or 374)

Before keying a manual claim or resubmission the DB1 must be completed in full.

The following details must be supplied:

• Service Provider Details - name and provider number or name and practice address
• Payee Provider Details - if applicable, name and provider number, or name and practice address
• Date of claim - Where two claims are lodged with the same date, Service Officers can change the date to the day after for one of the claims. If the provider number has closed, change the date to the day before
• Claim ID - Batch reference consisting of 1 alpha and 4 numeric for outpatient services (DBIN), or symbol # and 4 numeric for inpatient services (DBIH)
• Number of assignment forms - number of vouchers in the batch (see note below)
• Total benefit amount - total sum of all benefits in the batch (see note below)
• Health professional signature
• Witness signature - a sole health professional that is unable to have a bulk bill header witnessed with a signature, should indicate this by notating 'sole practitioner' in the witness signature field
• Witness name

Note: if the missing or incorrect information on the DB1 is not claim related, for example number of assignment forms or total benefit amount, Service Officers must attempt to contact the health professional for the details.

If the health professional cannot be contacted or the missing and/or incorrect information is claim related, return the entire claim to the health professional with the appropriate standard letter template.

Before keying a manual claim or resubmission, the patient must be able to be uniquely identified on the assignment of benefit form. For example the patients Medicare card, IRN and full name or the patient’s full name and DOB.

Use the information provided (name and date of birth) to find the Medicare number through a CDMS search if this has not be provided on the claim.

The following information must be supplied:

• Patient name
• Patient signature/consent - signature of patient to assign the right of the benefit to the health professional
• Patient unable to sign - where patient is unable to sign the health professional must give a reason, for example fractured hand or dementia
• Date of service - date the services were rendered
• Item number - MBS item number for services rendered
• Benefit assigned - benefit amount per item
• Health professional details - name and provider number or name and practice address of rendering health professional (must match details on DB1)
• Referral health professional details - name and provider number or name and practice address of referring health professional and referral date
• Number of patients attended - to be used for derived attendance items, for example 24/5, 47/1

If the patient cannot be uniquely identified, or if the mandatory claim details on the assignment form are missing, the DB1 and assignment of benefit form must be returned to the health professional with the appropriate standard letter template.

Note: for Easyclaim resubmissions, Easyclaim receipts are acceptable in place of an assignment of benefit form.

• Key DXEI
• Press [Enter]

Complete the following fields with the information on the batch header:

• Payee Provider - only required if supplied
• Service Provider
• Claim ID
• Date of lodgement - the date the claim was lodged
• Claim Date - date of claim
• Claim Type - identifies what screen is needed to process the claim. For example General, Pathology, Diagnostic Imaging
• Option - K is automatically populated to allow the service officer to key. This does not need to be changed
• Vouchers Quoted
• press [Enter] then [F9] to continue

• Complete the following fields with the information on the assignment of benefit vouchers (DB2):
• CARDNUMBER - the quoted Medicare number on the DB2 voucher
• # - the first initial of the patient’s first name
• DOS - the date on which the service was rendered. Only DD MM can be keyed.
  Note: if the DOS is older than 12 months, '?' must be keyed. The date will be entered at the payment stage
• ITEM - the MBS item for services rendered
• BN-ASG - the benefit assigned to the item number of the DB2 voucher
• press - [Enter]

Note:

• if there is more than one item on the voucher, key the next item in the line below and up to 5 items can be keyed per voucher. If there are more than 5 items a ? can be substituted in the 5th item field, then additional items can be keyed in at the assessing stage
• for derived fee items, ensure the amount of patients seen is keyed with the item in the item field (that is, 47/2)

Press [F3] to close the claim.

The claim will go into 'D/E COMP' status after data entry while the system assesses the claim.

Note: if voucher count is different to amount keyed, Key C in the OPTION field to close the claim.

Key DQOI to show the claim status.

If claim status is:

• 'ASS/PAID', go to Step 7
• 'WAITPEND', go to Step 8

Note: use Control Line DAPI,PROVIDERNUMBER,CLAIM ID must to get a claim where it does not show in the DQOI screen. For example, DAPI,123456AB,A0001

Where a '?' has not been keyed in the claim when keying data:

• key DCPI, OPERATORNUMBER, P
• key S to select in A (Action) field
• key U to update and finalise claim

Note: if the Service Officer does not use control line DCPI the claim/s will not be released for payment. When keying your P number in the control line do not include the 'P'.

If there are no errors the system will automatically pay the claim and show 'ASS/PAID' to indicate claim has been assessed and paid.

• Key S to select in the A (Action) field
• Press [Enter] to acknowledge payment and show statement
• Press ESC to clear the screen
• Key DQOI to review next claim

If there are errors or the claim requires more details, the system will show 'WAITPEND' or 'IN PEND' to indicate the claim is in pend until further action.

• Key S to select in the A (Action) field
• Press [Enter]

If there are errors, or the claim requires more details the system will automatically open the claim to the voucher that requires assessing.

• For more details about pathology items, see Assessing Pathology claims
• press [F1] under return messages for instructions and key information as required
• review and apply assessing restrictions by following warning messages
• warning messages must be actioned in order from left to right and further explanations can be viewed by placing the cursor at the beginning of the return message and press [F1]
• press [F3] to move on to the next error until all vouchers have been resolved
• if the claim has all errors resolved, go to Step 10
• if the claim contains a voucher that requires an adjustment, go to Step 12

Once all errors are resolved, Mainframe will show the message 'NO ERRORS OK TO PAY'.

Over key:

• DAPC with DPPI and press [Enter]
• 'I' with 'P' to pay the claim and press [Enter]

The confirmation screen will show with the DQRI line and the message 'PAID OK' to indicate successful payment of claim.

Procedure ends here.

Bulk bill manual claims and resubmissions that require an adjustment must be put into the BB>BBADJ folder in PaNDA.

• Select File > Save As from the menu
• Save the file to a temporary folder on desktop
• Delete the vouchers that have been processed and do not require an adjustment:
• select Page Thumbnails
• right click on pages that require deleting
• select Delete Pages
• press OK

Note: make sure the Bulk Bill header remains in the file.

• upload the file through the PaNDA Document Upload tile
• select Create New Work Item from Upload Type field
• browse to find your saved document on desktop
• select program Bulk Bill
• select work type Adjustments
• add particulars such as Provider number and Claim ID
• add Processing notes as required
• select Upload Document
• wait approximately 3 minutes for the upload process to finalise
• if appropriately trained, locate the document through the PaNDA search function, assign to self and action per standard bulk bill adjustment procedures