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Processing radiation oncology 011-43010150



This document details how to process radiation oncology claims in a timely and efficient manner to make sure national consistency is maintained.

From 1 July 2024

On this page:

Process kilovoltage accounts/invoices for multiple sites

Process claims for multiple sites

Note: if the account/invoice has:

Table 1: this table describes how to pay a radiation oncology claim with multiple planning or treatment sites with a date of service from 1 July 2024.

Step

Action

1

Check date of service + Read more ...

From 1 July 2024, separate processes apply when processing radiation oncology claims depending on the date of service. Service Officers must follow the process relevant to the date of service they are processing.

If the date of service is:

2

Start processing claim + Read more ...

3

Identify sites + Read more ...

Identify:

  • the first planning or treatment item
  • each additional anatomical site

Note: this information is populated by the health professional for online claims.

The Resources page has a list of items.

4

Read claim text and/or supporting information + Read more ...

Read any text or annotation provided by the health professional to confirm each anatomical site being claimed.

5

Assess claim + Read more ...

Check and read all return messages in full:

  • press [F1] to display multiple pages and actions where necessary
  • press [F1] again to display multiple pages and actions in each return message

The Resources page includes radiation oncology return messages and resolutions.

6

Finalise claim + Read more ...

  • Press Enter
  • Key P to pay claim

Before 1 July 2024

On this page:

Process accounts/invoices

Key the amount charged from the account/invoice

Process accounts/invoices

Note: if an individual charge is over $9,999.99, see the relevant table in Charges $10,000 or more (greater than $9,999.99) for Medicare patient claims.

Table 1: this table describes how to pay a radiation oncology claim with 2 or more fields for accounts/invoices with a date of service before 1 July 2024.

Step

Action

1

Check date of service

From 1 July 2024, separate processes apply when processing radiation oncology claims depending on the date of service. Service Officers must follow the process relevant to the date of service they are processing.

If the date of service is:

2

Identify fields

Identify the:

  • single field base item on the account/invoice
  • matching additional field derived fee item
  • number of additional fields on the account/invoice/text for the additional field derived fee item

Note: this information is populated by the health professional for online claims.

The Resources page has a list of items.

2

Key details

Key the:

  • details for the first single field base item, and
  • details for the matching additional field derived fee item on the next line, then
  • number of additional fields in the NO field for the additional field derived fee item. The maximum number of additional fields is 5

Note: Service Officers must key multiple treatments on the same day, in separate claims.

Manual claims

Service Officers must key a:

  • separate claim for all base items that have a correlating derived fee item
  • new claim for each individual combination of base and derived fee items

Electronic claims

For electronic claims, the first base and derived fee items must be paid, and subsequent items rejected. See the Resources page for the rejection codes. Health professionals must resubmit a separate claim.

Repeat this step for the remainder of items.

For:

3

Key LSPN and equipment number

  • In the Fee field, key the Location Specific Practice Number (LSPN) and equipment number
  • Preceding zeros are not required for the LSPN. For example, key L0125 as L125

Note: this information will be populated by the health professional for online claims.

4

Return messages

Check all return messages in full:

  • press [F1] to display multiple pages and actions where necessary
  • press [F1] again to display multiple pages and actions in each return message

The Resources page includes radiotherapy return messages and resolutions.

Key the amount charged from the account/invoice

Table 2: this table lists the actions taken to record the amount charged.

Step

Action

1

Identify charge type + Read more ...

Check the amount charged on the account/invoice:

  • Single amount charged for each item, go to Step 2
  • One amount charged for combined single field base item and matching additional field derived fee item, go to Step 3
  • One amount charged for the combination of all items on the account/invoice, go to Step 4

2

Single amount charged for each item + Read more ...

Key each amount in the charge field against each item.

3

One amount charged for combined single field base item and matching additional field derived fee item + Read more ...

Key:

  • the amount charged against the single field base item, and
  • zero in the charge field for the additional field derived fee item

The Resources page has a list of items.

4

One amount charged for the combination of all items on the account/invoice + Read more ...

Key:

  • the amount charged against the first single field base item as a notional charge, and
  • zero in the charge field for all remaining items