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Bulk bill late lodgement claims in Medicare 011-43030020

This document outlines details about late lodgement of bulk bill claims in Medicare.

On this page:

Request delegate approval for a late lodgement

Culled history check

Request delegate approval for a late lodgement

Table 1: this table describes the process for Service Officers seeking delegate approval.

Step	Action
1	Assess claim for documentation Service Officers assess claim for: correct and completed documentation DB019 – application for late lodgement reason for late lodgement if compliance is listed as the reason for late lodgement, Service Officers must search for the listed case number and make sure that all services being claimed were a part of a NCO (Non Compliance) check culled history to make sure items have not been previously paid, see Culled history check table a copy of the culled history report must be uploaded to the PaNDA file Can the Service Officer approve late lodgement? Yes, go to Step 3 No, or documentation is incomplete, go to Step 2 Note: late lodgement applications must only be processed by appropriately skill tagged Service Officers.
2	Return claim to health professional Return the claim with the Z1664 – Provider late lodgement not approved letter and upload to PaNDA for filing. Procedure ends here.
3	Record recommendation Enter a comment in PaNDA explaining the reason for recommendation to approve and pend the claim for delegation approval.
4	Delegate decision The delegate must enter comments in PaNDA stating whether the late lodgement is approved or rejected. If the delegate: approves the late lodgement, the claim is allocated for assessing. See Bulk bill claims in Medicare for processing details and control lines does not approve the late lodgement, return the claim to the health professional with the Z1664 – Provider late lodgement not approved letter requires further escalation, see Medicare Claims Helpdesk for determination

Culled history check

Table 2: this table describes the process for accessing and using the SAS portal to verify a Medicare benefit has not been paid.

Step	Action
1	Access SAS If prompted, enter: Username = Logon ID (AAA123 or P12345) Password = Universal Password
2	For 2 to 5 year claims Select the Parameter-Based Reporting tab. Select Medicare Patient History. Complete the web form and select Submit request. Note: Pin/s field requires the Medicare PIN, minus the alpha Dates of service must be in DD/MM/YYYY format Report Format Types can be changed to suit processing style The system may take several minutes to produce the reports The culled history report will be ready for use. A copy of the report/s must be uploaded to the PaNDA file to support the assessment of the late lodgement claim.