Skip to navigation Skip to content

Process Medicare Safety Net claims 011-43080040

Expand/Collapse all sectionsExpand all



This document outlines information on processing claims when a new Safety Net threshold has been met and in particular Services Australia's acceptance of partially paid claims. Note: as at 1 July 2016 Norfolk Island is covered under Medicare provisions.

On this page:

Selecting the correct Safety Net family for Medicare claims

Selecting the correct Safety Net family for Medicare patient claim adjustment

Selecting the correct Safety Net family for Medicare claims

Table 1: this table provides an example of how Service Officers process a claim where a person is registered on two Safety Net family registrations.

Expand table

Step

Action

1

Key claim details

The warning message 1-SEL FAM is displayed, where a person is registered on two Safety Net family registrations.

2

Determine which Safety Net family paid

Determine which Safety Net family paid for the service by checking the claimant details.

3

Select the correct Safety Net family

Select the correct Safety Net family by positioning the cursor under the relevant family registration and press [F5].

Note: when the family Safety Net registration still cannot be identified use the servicing provider postcode and select the registration with the closest postcode. Further investigation may be required if the Service Officer cannot establish which family Safety Net family paid for the service.

4

Process claim

Process the claim.


Selecting the correct Safety Net family for Medicare patient claim adjustment

Table 2: this table describes how Service Officers process a Medicare patient claim adjustment where a person is registered on 2 Safety Net family registrations.

Expand table

Step

Action

1

Adjusting services

Services to be adjusted:

  • key NHSI, Medicare card number, patient's IRN or first initial
  • press [Enter]

2

Display the services for latter day adjustment (LDA)

In the AC (action) field:

  • key AD alongside the service line(s) to be adjusted
  • press [Enter]

The standard patient claim processing screen containing original processing information will be displayed.

3

Adjusting claim

Adjusting the claim:

  • adjust an item number, date of service, charge, provider, patient by over keying the incorrect information with the correct details
  • press [Enter]

If the warning message 1-SEL FAM is displayed, the person is registered on 2 Safety Net family registrations.

Select the correct Safety Net family by:

  • positioning the cursor under the relevant family registration
  • press [F5]

If unable to determine the correct Safety Net family, go to Step 4.

If the correct Safety Net family is determined, go to Step 5.

4

Determine which Safety Net family paid

Determine which Safety Net family paid for the original service by checking the patient’s history:

  • key NHSI, Medicare card number, patient's IRN or first initial
  • press [Enter]
  • locate the service to be adjusted
  • place the cursor under the benefit
  • press [F1]

The Family No will be displayed at bottom of screen.

Return to the adjustment and select:

  • the correct Family No by positioning the cursor under the relevant family registration
  • press [F5]

5

Assessing the claim

Review and apply assessing restrictions by following the warning messages.

Warning messages must be actioned in order from left to right. To view further explanations:

  • place the cursor at the beginning of the return message
  • press [F1]

Note: the adjustment can affect the Medicare Safety Net and extra benefits may be payable. If Safety Net needs to be confirmed, see Amend or confirm a registered Medicare Safety Net family.

6

Finalise the claim

To finalise the claim:

  • key A to adjust
  • press [Enter]
  • key P to pay claim