Bulk bill claims in Medicare 011-43030000

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 through 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)
• pended
• rejected
• 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 following details 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)

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

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. In some cases, claim rejections require further investigation because of:

• 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

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 letter.

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 letter.

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]

If there:

• is more than one item on the voucher, key the next item in the line below. Up to 5 items can be keyed per voucher
• 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
• are 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.

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

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

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.

• If the Medicare card is expired, reject the claim with (Reason code 374)
• 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
  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

Before processing the request, staff must make sure a:

• manual payment has not already been requested, and
• benefit has not already been paid

Complete the following checks:

• PaNDA, to make sure there is no manual payment request already. See Processing and National Demand Allocation (PaNDA)
• CDMS personal comments for details of a previous manual payment for the service
• SAS Portal to verify that a Medicare benefit has not been paid. See Table 2 in Bulk bill late lodgement claims in Medicare

If the request is:

• payable, go to Step 2
• not payable, procedure ends here

In PDS, check for the provider's bank details.

From the Provider Location View screen:

• Key stem with Location - 1234567 - Medicare Stem + Location
• Select Search
• Select Program Registration
• Locate the Program – MCARE row
• Select View under the action column
• The Program Registration View page will show
• Check the banking details under the Current Payment Instruction section

If there are valid details recorded, go to Step 3.

Where no valid details are recorded, contact the health professional and tell them:

• banking details are needed to make the payment. They can provide bank details:
• through HPOS, or
• by lodging Bank Account details for Online Claiming (HW052) form
• the Medicare benefit/s will be held until bank details are received. Procedure ends here

Staff must complete the:

• Bulk Bill Manual EFT statement template. See Resources > Bulk Bill Manual EFT statement. Include these details:
• Providers full name and address details as per PDS. If the Provider is a Business or organisation, enter the details as per the DB1 Header
• Reference ID: 10-digit PaNDA work item ID
• Manual EFT Payment Request form (PP048). When completing this form make sure:
• to use one form per Claim Id
• that the total amount payable is on the form
• that all details are in capital letters
• the entire form is complete, all fields are mandatory

Save both documents to the MPS Claims and Assessing shared drive:

• Combine them into one file and save them as a pdf
• Use the file name format 'BB/Surname First name/Provider number/Operator number'
• Save them in the following folder:
• 1.Manual Payment Requests > select relevant state folder > 3.BULK BILL\FORMS BB > YEAR > MONTH
• Folders are listed in weeks. Find the relevant weekly folder, add the saved documents to that folder
• If the folder is marked as closed, this means it has been sent for payment. Add the documents to the following week

Staff must also upload the documents to the PaNDA work item.

In PaNDA:

• select the Notes icon at the top of the screen:
• in the Processing Notes field key:
• details of change in items
• date of service
• EFT amount. Round this to the nearest 5 cent
• Provider number
• select Confirm

A message will show at the bottom of the screen saying the 'Processing Note was successfully submitted'.

For example:

Man EFT for [$amount of payment]. XXXX item changed to XXXX item. DOS (DD/MM/YY). Provider number 123456A.

Pend the claim until a copy of the remittance advice is received from the Service Support Officer (SSO).

Access the Vendor Request Template from the MPS Claims and Assessing shared drive:

• Relevant state folder > BULKBILL > BULK BILL VENDOR REQUEST SPREADSHEET > YEAR > MONTH > RELEVANT WEEK ENDING
• The spreadsheet can have up to 200 vendor lines only. Make multiple files if needed
• Capitalise as needed. For example, capitalise First and Surname
• Do not remove any columns even if blank
• The template must only have numbers and letters:
• Hyphens (-) are accepted in the name or address columns only
• Backslash (/) is accepted in the address column only
• Do not use symbols, including:
• Comma (,)
• Colon (:)(;)
• Ampersand (&)
• Full stop (.)

Update the template, see How to update vendor request spreadsheet for creation of MBS vendors.

Save the spreadsheet

• Save the spreadsheet in the folder:
• Select the relevant state folder > BULKBILL > BULK BILL VENDOR REQUEST SPREADSHEET > YEAR > MONTH
• Folders are listed in weeks. Find the current weekly folder, add the saved documents to that
• If the folder is marked as closed, this means it has been sent for payment. Add the documents to the following week

• Access the Payment Run Request Template from the MPS Claims and Assessing shared drive
• Update the template, see How to update payment run request spreadsheet for creation of MBS payments

Save the spreadsheet

• Save the spreadsheet in the folder:
• Select the relevant state folder>BULKBILL> BULK BILL PAYMENT RUN SPREADSHEET > YEAR > MONTH
• The folders are named week ending. Add the details to the form for the current week. This should match the same period as the Vendor Request Template
• If the folder is marked as closed, this means it has been sent for payment. Add the documents to the following week

After completing and saving all documents, send an email:

• to the Team Leader, who will forward it on to the quality checking Local Peer Support (LPS)
• in the Subject field enter Bulk Bill Manual Statement [PROVIDER NAME/ NUMBER]
• in the email, include that the claim is PENDED in PaNDA and awaiting manual EFT payment

These are all stored in the MPS Claims and Assessing shared drive in the following folders:

• Manual EFT Payment Request form (PP048) - 1.Manual Payment Requests > select relevant state folder > 3.BULK BILL\FORMS BB > YEAR > MONTH
• Bulk Bill Manual EFT statement template - 1.Manual Payment Requests > select relevant state folder > 3.BULK BILL\FORMS BB > YEAR > MONTH
• Vendor Request Template - relevant state folder > BULKBILL > BULK BILL VENDOR REQUEST SPREADSHEET > YEAR > MONTH
• Payment Run Request Template - relevant state folder > BULKBILL > BULK BILL PAYMENT RUN SPREADSHEET > YEAR > MONTH

Check the following:

• Manual EFT Payment Request form (PP048) has:
• one form per Claim Id
• the total amount payable
• all details in capital letters
• been completed in full, all fields are mandatory
• Details keyed on the PP048 form match the details entered on:
• the manual EFT statement
• Vendor Request Template
• Bulk bill manual EFT statement has been completed in full and details are correct
• Vendor Request Template has been completed, and details match the PP048 form. Also check that it:
• is not over 200 vendor lines
• includes capitals as needed. For example, capitalise First and Surname
• has not had columns removed
• includes only numbers and letters, except for
  Hyphens (-) in the name or address columns only
  Backslash (/) in the address column only
• does not include symbols, such as commas, colons, ampersand (&), or full stops
• Payment Run Request Template has been completed and details are correct, as per How to update payment run request spreadsheet for creation of MBS payments
• In PaNDA make sure:
• documents have been uploaded
• comments have been added

If all details are:

• correct, go to Step 3
• incorrect, return the work item to the Service Officer to make any corrections

Send an email to Provider Services Support and include the following:

• Subject line: BB manual EFT - Provider number [enter provider number] week ending ddmmyy
• Email body: The work item has been checked, templates are completed and correct
• Attach a copy of the Manual EFT Payment Request form (PP048)

Quality check the following:

• Request forms
• Statement of benefit
• Provider banks details recorded on PDS for the location

• Go to the folder Perth 556 Wellington > MPS > Assessing Claims and Simp Bill > Manual EFT > BULK BILLING Vendor request
• In that folder, open the Bulk Bill payment run requests from each state
• Copy the details from each state's Vendor Request spreadsheet into the National Vendor request spreadsheet. This is in the National Health Service Delivery folder in HZSAV > MPS-National > MPS_Claims_&_Assessing > 1. Manual EFT Payment Requests
• Save as the associated week ending date

Send an email:

• to the Accounting Operations (AO) team
• from the Provider Services mailbox
• with the Subject field as 'Bulk bill payments - Vendor requests - Medicare Provider Services'
• use the email template in Outlook > Provider Services Support mailbox > Medicare Bulk Bill Claim Payments > Vendor Requests > Medicare Provider Services

The AO team will:

• create a new vendor maintenance number
• add this to the spreadsheet
• return the spreadsheet to the requesting staff member

• Go to the folder Perth 556 Wellington > MPS > Assessing Claims and Simp Bill > Manual EFT > BULK BILLING Payment run request
• In that folder, open the Bulk Bill payment run request from each state
• In the National Payment Run template:
• Copy the details from each state, and
• Add the Vendor maintenance number in the A - Vendor field, and
• Save as week ending ddmmyy

Delegate (EL1) approval is needed before the payment can be made Calculate the total amount to be paid and number of payments.

Send an email to the appropriate delegate in Provider Services. Include the following:

• Use the email template in Outlook > Provider Services Support mailbox > Manual EFT Payment Run > Delegate Approval > Medicare Provider Services.
• Subject field - 'Bulk Bill Payments - Manual EFT Payment Run - Medicare Provider Services'
• Email text:
• Please find attached for your approval, a request for [insert number of payments] manual EFT payments for the total amount of $[insert total amount]

After receiving delegate approval, forward the email as follows:

• To - Medicare Cash Management
• CC -Medicare Treasury Helpdesk
• BCC - Provider Services
• Include in the Subject field [Bulk Bill Payments - Manual EFT Payment Run - Medicare Provider Services]
• Enter the Email text as:
• Please find attached the spreadsheet for [Insert number of payments] payments for the total amount of $[Insert Total amount] which has been approved for payment as per delegation limit of [Insert Delegate name]
• Attach a copy of the EL1 approval email

Medicare Cash Management will email when payment has been processed and released to the Reserve Bank of Australia (RBA).

SDST SSO will send an email to the requesting Service Officer that includes:

• advice that payment had been made
• a copy of the remittance advice from Medicare Cash Management
• advice that they can issue the health professional a manual statement of benefit and remittance advice
• advice that they can upload both these documents to the PaNDA work item