Online statement and features for bulk bill LDA claims in Medicare 011-43040050

The on-line DPSI transaction displays the patient details included in a claim.

If an adjustment has occurred the DPSI of the original claim displays the reason codes:

• 888 original line
• 889 transferred
• 898 suppressed
• 816 underpayment
• 818 overpayment

against the original lines that were adjusted.

To view the restated lines the adjusted claims date of lodgement (DOL) is required on the DPSI control line. Only restated lines are displayed.

Note: these screens should not be printed by operators and sent to providers.

If an original claim is requested where adjustments have taken place, the adjustment details will not be displayed on the duplicate statement.

When a duplicate statement is required for the details of an adjusted claim, both original and restated lines are printed, unlike the view of on-line DPSI for these claims.

Suppressed services are not printed on duplicate statements and can only be viewed online.

These adjustments are processed for internal record keeping purposes only and must not be communicated to providers or patients.

When the DHAU control line is entered the system updates patient claims history with all original, new and restated details. With the implementation of the bulk bill later day adjustment on adjustment, all adjustments to item data will be performed on the DHAC screen.

The bulk bill LDA system allows only one active adjustment claim for each original claim at a time. An active claim is one which does not have a status of ADJ PAID, ADJ HIST or ADJ OPAY. If processing commences on another adjustment claim for the same original claim while an 'active' claim exists the system returns the error message EXIST ADJ.

Use the DCEI screen to establish the status of the existing adjustment claim. Using the appropriate control line access the adjustment claim and if possible process the additional adjustments.

If it is not possible to process the additional adjustments, for example, the claim has passed through background assessing and the patient details requiring adjustment have been removed from the claim, process these adjustments in a separate adjustment claim after the 'active' claim has been finalised.

To initiate a subsequent adjustment the operator is to enter the original claim date of lodgement (DOL) on the DHSI control line.

When an adjustment claim has been processed, any subsequent adjustment claim/s for the same original claim must have a different DOL. The system sets the DOL for the adjustment claim to the day after the original DOL.

Entry of the DHSI control line for a second adjustment claim before the overnight process has been completed results in the system returning the error message 3-STATUS.

Note: Service Officers cannot adjust the same claim more than once on any given day.

The DCEI screen must first be assessed to determine the status of the existing adjustment claim.

The processing procedures from this point vary depending on the status of the claim see the Resources page for further details.

When an adjustment claim is received for a split claim, it is possible not all of the adjustments are contained in only one part of the split claim.

The adjustment claim must be divided into two or more adjustment claims so that the adjustment vouchers in each claim correspond with those contained in each part of the original claim.

The following screens have been altered to reflect the action taken in the adjustment:

• PDB - Processing bulk bill
• PDE - Processing bulk bill EDI
• PDS - Processing bulk bill scanning
• PDM - Processing bulk bill manual

The following outlines the changes to the three lines that report details of adjustment processing. This is due to transfer actions including 2 PINS.

• Old line - claims = New line - claims
• Old line - PINS = New line - vouchers
• Old line - lines = New line - lines

Changes have been made to the existing data validation (RMDS) reports and 2 new reports have been created. The Resources page contains a list of existing and new RMDS reports.

As each stage of adjustment processing is completed the status of the claim changes and is recorded on the DCEI screen.

If the date of lodgement (DOL) is included in the control line the progressive status of the claim is displayed in the bottom left-hand corner of the screen.

The Resources page lists the DCEI progressive status values an adjustment claim may have.

The Resources page contains a list of the return messages which are unique to the DH** Bulk Bill LDA system. Many of the return messages generated in the bulk bill claims processing system, form part of the DH** bulk bill LDA system. However, the explanation for some of these messages varies significantly. Until the operator becomes familiar with the bulk bill LDA system, these messages should be accessed and read carefully.