Processing radiation oncology 011-43010150

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

If the date of service is:

before 1 July 2024, see Table 1 Step 1 on the Before 1 July 2024 tab

from 1 July 2024, go to Step 2

Identify the:

• single field base item (15952) on the account/invoice
• matching additional field derived fee item (15954)
• number of additional sites on the account/invoice for the derived fee item

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

The Resources page has a list of items.

Key:

• the details for the first single base item, and
• the details for the matching additional sites derived fee item on the next line, then
• key the number of additional sites in the NO field for the derived fee item 15954. The maximum number of additional sites is 10

Note: Service Officers must key multiple treatments with a base item and a derived fee item on the same date of service, in separate claims.

Manual claims

Service Officers must key a:

• separate claim for all base items that have an associated 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:

• manual claims, go to Step 3
• online claims, go to Step 4

Key the Location Specific Practice Number (LSPN) and equipment number in the FEE field. 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.

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 radiation oncology return messages and resolutions.

Key each amount in the charge field against each item.

Key the amount charged against the single site base item and key zero in the charge field for the additional site derived fee item.

The Resources page has a list of items.

Key the amount charged against the first single site base item as a notional charge and key zero in the charge field for all remaining items.

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

If the date of service is:

• before 1 July 2024, go to Step 2
• from 1 July 2024, see Table 1, Step 1 on the From 1 July 2024 tab

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.

Key:

• the details for the first single field base item, and
• the details for the matching additional field derived fee item on the next line, then
• key the 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:

• manual claims, go to Step 3
• online claims, go to Step 4

Key the Location Specific Practice Number (LSPN) and equipment number in the FEE field. 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.

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 each amount in the charge field against each item.

Key the amount charged against the single field base item and key zero in the charge field for the additional field derived fee item.

The Resources page has a list of items.

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