Patient Claims quality checking processing 111-22090020

Key QBBI and press [Enter].

The QBBI screen displays details of selected transactions to be quality checked.

Note: for more information on how to interpret information on the QBBI screen, see the Quality Control System (QCS) for Medicare in Resources

The details returned on the QBBI screen format for patient claims transactions include:

• PRC DT - processing date
• TIME - time of processing
• OPER - logon ID of the Service Officer who processed the transaction
• TY - transaction type - values are:
• CT - Credit EFTPOS (payee code 7)
• FT - EFT (payee code 9)
• QD - cheque to doctor via claimant (payee code 2)
• TRAN - transaction that was updated
• REFERENCE DETAILS - the Medicare card number selected for quality checking

Select the transaction to be checked by positioning the cursor in the 'S' (select) field then pressing [Enter].

Medicare patient history screen displays the claims history of the transaction selected.

To view the transaction timestamp for each item line, press [F9]. The timestamp on history must uniquely match the time of the selected transaction on QBBI.

Manual

• Find the transaction source document, that is, hard copy/digital image
• Compare the source document(s) with the claim’s history displayed and determine if the patient claim was processed correctly
• Go to Step 4

Online

• Examine history to determine what Service Officer intervention has occurred
• Check PI codes, reason codes, rejections, and text messages to determine if the patient claim has been processed correctly
• If the intervention cannot be determined, update the transaction as error free

After examining the transaction and source documents, press [F3] to exit from history and return to the QBBI screen.

QBBI shows b (browse) in the S field and is now ready to accept status codes in the STATUS field to indicate whether or not the transaction had been processed correctly or incorrectly. See Resources for status codes.

In the STATUS field for the transaction selected, key one status code and press [Enter]. This should be the error with the greatest impact.

QBBI returns a lower case u in the S field to advise that the selection has been updated with a status code.

For multiple transactions related to the same Medicare number that have:

• the same time stamp:
• quality checkers must only action the first transaction line with a valid status code
• leave additional duplicate transaction lines unactioned. They will automatically be removed from QBBI after 21 days
• different time stamps:
• quality checkers must action all transaction lines with a valid status code
• the relevant status code must be applied against the corresponding time stamp

Note: if no status codes have been keyed, the system returns a b to show that the selection has been browsed, but not finalised.

When all transactions have been actioned press [F3] to exit the QBBI screen.

Each time a quality check is completed, the quality checker must:

• email the Service Officer and their Team Leader advising the quality check outcome
• use the relevant QBBI quality checking email template for sending emails. The Resources page contains these templates

Manual

Endorse the source documents and batch envelope with:

• QC
• Quality Checker's signature
• date

Note: do not write on the front of source documents. This ensures information is not obscured if required to be reviewed in the future.

Note: see Resources for links to the Medicare Error Explanation form.

For errors identified:

Manual:

• Return a copy of the claim with a brief description of the adjustment required:
• to the Service Officer for correction, or
• send to the appropriate section in the program for actioning
• Enter the error information on the Medicare Error Explanation form. Ensure all errors identified in the checks are recorded on this form

Online:

• Print the patient claims history twice and endorse with a brief description of the adjustment required
• Return a copy of the prints to the Service Officer for correction or send to the appropriate section in the program for actioning
• Complete and submit the Medicare Error Explanation form. Ensure all errors identified in the checks are recorded on this form

See also The Quality Control System (QCS) for Medicare in Resources.