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Bulk bill late lodgement claims in Medicare 011-43030020

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This document outlines information 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 (SO) seeking delegate approval.

Step

Action

1

Assess claim for documentation + Read more ...

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 ensure that all services being claimed were a part of a NCO (Non Compliance)
  • check culled history to ensure 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?

Note: late lodgement applications must only be processed by appropriately skill tagged Service Officers.

2

Return claim to health professional + Read more ...

Return the claim with the Z1664 – Provider late lodgement not approved letter and upload to PaNDA for filing.

Procedure ends here.

3

Record recommendation + Read more ...

Enter a comment in PaNDA explaining the reason for recommendation to approve and pend the claim for delegation approval.

4

Delegate decision + Read more ...

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 information 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, refer to 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 + Read more ...

If prompted, enter:

  • Username = Logon ID (AAA123 or P12345)
  • Password = Universal Password

2

For 2 to 5 year claims + Read more ...

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.