Skip to navigation Skip to content

Bulk bill incentive items in Medicare 011-43030030

This document outlines information about bulk bill incentive items for Medicare.

On this page:

Checking patient history for concessional status

Checking patient for concessional status

Checking patient history for concessional status

Table 1: this table describes how to display a patient's concessional eligibility in the patient history enquiry screen through Mainframe.

Step	Action
1	Identify the provider Request the following details from the caller: provider or prescriber number full name of the provider practice location for the provider number supplied. Note: practice name or nearest corner, including street name and suburb is acceptable as practice location requirements See Perform telephone security check for Medicare health professionals.
2	Caller permission Ask the caller: 'Do you have permission from the patient to request their concessional entitlement and have you explained to the patient why you need this information?' Does the caller have permission? Yes, go to Step 3 No, the caller that cannot be provided to them. If the caller disputes this, transfer call to the team leader. Procedure ends here
3	Access the Medicare claims history Go to the NHOI screen and key card number, patient's IRN or first initial. Press [Enter]
4	Locate patient name Place the cursor under the patient name Press [F1] This will display CSN ELIG details
5	CSH ELIG details CSN ELIG details will display as either: Y concessional N non-concessional
6	Confirm status with provider Provide the concessional status of the patient to the provider If the provider disputes status, escalation process to be put in place. See Medicare and Aged Care - Local Peer Support (LPS)

Checking patient for concessional status

Table 2: this table describes how to display a patient's concessional eligibility using the RPQN enquiry screen.

Step	Action
1	Identify the provider Request the following details from the caller: provider or prescriber number full name of the provider practice location for the provider number supplied. Note: practice name or nearest corner, including street name and suburb is acceptable as practice location requirements See Perform telephone security check for Medicare health professionals.
2	Caller permission Ask the caller: 'Do you have permission from the patient to request their concessional entitlement and have you explained to the patient why you need this information?' Does the caller have permission? Yes, go to Step 3 No, the caller that information cannot be provided to them. If the caller disputes this, transfer call to the team leader. Procedure ends here
3	Check information Check this on Provider Directory System (PDS).
4	Entering patients details Key the patient's details quoted by the GP on the RPQN screen. If the patients' concession number is: Known by the GP: enter this in the entitlement ID. press [F9] ELIGIBILITY DETAILS go to Step 5 Unknown by the GP: ask for the patient's surname, first name and date of birth. Press [Enter]. press [F9] ELIGIBILITY DETAILS go to Step 5 More than one person comes up on the concession screen: Enter the number next to the person Press [F9] ELIGIBILITY DETAILS go to Step 5 Was the patient's details located? Yes, go to Step 5 No, See Medicare and Aged Care - Local Peer Support (LPS)
5	Checking concessional status and GP eligibility If the patient is concessional, conc will appear in the level code column. To confirm if the patients concession card entitles the GP to claim the bulk bill incentive: on the row where 'conc' appears, check the concessional reason code under the ENT DESC column check if the concession card type entitles provider to claim The following concession cards entitle GPs to claim a bulk bill incentive payment: Centrelink Commonwealth Seniors Health Card (CSHC) Health Care Card (HCC) Pensioner Concession Card (PCC) Department of Veterans' Affairs (DVA) Pensioner Concession Card (PCC) Commonwealth Seniors Health Card (CSHC) Note: holders of a DVA Veteran Card-All Conditions or Veteran Card-Specific Conditions are not eligible for the bulk bill incentive payment unless they also hold a recognised Commonwealth concession card and choose to be treated under the Medicare arrangements. Help information - [F4] is the help key, place the cursor under any information on this screen press [F4] to provide an explanation.
6	Confirm status with provider Provide the concessional status of patient to the GP.