Online statement and features for bulk bill LDA claims in Medicare 011-43040050

This page contains the processing procedures for subsequent adjustment claims, a list of existing and new RMDS reports, DCEI progressive and final status values for adjustment claims and a list of new return messages and definitions.

Status dependent processing of subsequent adjustment claims

Subsequent adjustment claims processing procedures based on claim status

Table 1: This table describes the processing procedures for subsequent adjustment claims depending on the status of the claim.

If the claim status is…	then…
ADJ PAID ADJ HIST, or ADJ OPAY	either wait until the next working day and recommence processing the second adjustment claim, or reverse the update of the adjustment claim by using delete the claim control line and start processing again to include the additional adjustments
ADJUST, or ADJ ENTRY	either access the adjustment claim and process the additional adjustment, or wait until the status of the adjustment claim is ADJ PAID, ADJ HIST or ADJ OPAY and the date of payment (DOP) is not today's date, as described above, then recommence processing of the subsequent adjustment claim
ADJ COMP	wait until the claim status changes to ADJUST and process as for ADJUST or ADJ ENTRY as above

Existing reports

Note: MCR 512 and MCR 513 will no longer generate new information as ADJ OPAY and ADJ HIST claims are no longer held.

Existing RMDS reports

Table 2: This table contains a list of existing data validation (RMDS) reports, including changes made.

Report	Description	Change
MCR 511	Latter day adjustments (LDA) daily age analysis	No change.
MCR 512	LDA date of lodgement (DOL) status analysis	No longer generated.
MCR 513	LDA held age analysis	No longer generated.

New reports

New RMDS reports

Table 3: This table contains a list of new data validation (RMDS) reports, including content.

Report	Description	Content
MCR 514	Latter day adjustments (LDA) overpayment report	Shows all claims that resulted in an overpayment and is generated weekly.
MCR 515	LDA suppressed reports	Shows all services suppressed in claims and is generated monthly.

DCEI progressive

DCEI progressive status values for adjustment claims

Table 4: This table lists the DCEI progressive status values an adjustment claim may have.

Status value	Description
ADJ ENTR	Entering of adjustment details to the claim may commence or has already commenced but has not been completed. This status may also mean that an operator has failed to 'close' the claim after entering all adjustment details.
ADJ COMP	Entry of adjustment details is complete and the claim is closed. The claim has been placed on the background assessing queue and will be assessed shortly.
ADJUST	The adjustment claim has passed through background assessing or has been reversed using the DHRI control line. To finalise the adjustment process the claim must be called up using the DHAI control line and the operator must access each screen, even when there are no error/warning messages. Any assessing errors must be resolved before the adjustment claim can be updated.

DCEI final status

DCEI final status values for adjustment claims

Table 5: This table lists the DCEI final status values an adjustment claim may have.

Status value	Description
ADJ HIST	The adjustment claim has been updated. The result of all adjustments in the claim is either: no change to benefit paid, or an underpayment of less than $1.00
ADJ PAID	The adjustment claim has been updated. The result of all adjustments in the claim is an underpayment of $1.00 or more. The claim is paid in the next overnight run.
ADJ OPAY	The adjustment claim has been updated. The result of all adjustments in the claim is an overpayment.

New return messages

New return message definitions, screens and conditions

Table 6: This table lists the new return messages which are unique to the DH** Bulk Bill latter day adjustments (LDA) system.

Return message	Definition	Screen	Condition/field
INV SUPRES	(Warning) You are attempting to perform multiple actions. Check action required.	DHSC	Action code H, M or F used in addition to date fields being over keyed.
MIXD TRANS	(Error) You have attempted to mix transactions. This adjustment cannot be reversed using DLRI. Refer to State headquarters.	DLRI	Attempting to reverse a DHSI adjustment with the incorrect control line.

Operational Information