About the Online Claiming Process

Send Bulk Bill claims to Medicare Australia Online or DVA claims to Department of Veterans' Affairs.

Before you begin

The following information is an overview of the steps and processes required for sending bulk bill claims to Medicare Australia Online or Department of Veterans' Affairs (DVA) claims.

Procedure

  1. Ensure you have an active Internet connection.
  2. Ensure you have recorded your practice's details.
  3. Ensure you have enabled Online Claiming. This is a global setting; once you have enabled it on one Pracsoft computer, everyone using the same Pracsoft database will also have this functionality enabled. Consider enabling EFTPOS/Medicare Easyclaim if you want to use these services and have installed the EFTPOS machine.
  4. Ensure you have installed and setup your Location Certificate and (if desired) individual practitioner PKI Certificate(s).
  5. Ensure all patients have their Medicare Card personal reference number recorded in Pracsoft. Once Medicare Australia Online has been activated, this requirement will be enforced whilst recording new visits.
  6. If you offer bulk billing for services provided at a hospital, you must record a Facility ID for each hospital you visit.
  7. A patient is then added to the Waiting Room, and a visit recorded for them. Alternatively, when conducting a home visit (or similar), you can record the visit without adding the patient to the Waiting Room by selecting Account > Add Visit from the patient's record or the Waiting Room.
    • When recording the patient's visit, indicate on the Record Visit window whether the visit is to be invoiced to Bulk Bill or DVA.
    • On the Record Visit window, click Claim to create a (claim) voucher for this visit. Vouchers are not immediately sent to Medicare upon clicking Claim. Instead, Pracsoft bundles the vouchers into claims. Each claim can contain multiple claim vouchers, one for each visit, up to a maximum of 80 claims, specified via Pracsoft's Global Settings Online Claiming tab.
  8. Before claims can be sent to Medicare, they must be batched. Batching a claim involves analysing or processing the claim to determine whether there are any inconsistencies that might prevent Medicare from accepting the claim, and assigning a claim number to it. Claim numbers can be added manually, but it is recommended that you have Pracsoft generate these numbers automatically for you by setting Auto-Claim No. Generation in the Pracsoft's Global Settings Online Claiming tab.
  9. Once a claim has been batched, it can be sent to Medicare with other batched claims immediately via Online Claiming. However, usual practice is to send claims in bulk, once a day, towards the end of the day. For sites using Medicare Easyclaim, claims are processed immediately via Medicare Easyclaim; it is not necessary to process the claims in Pracsoft, or batch them and send them manually in bulk lots.
  10. A request is sent to Medicare periodically, usually once per day, to provide you with exception reports or payment reports about previous claims you have sent. Reports can't be requested on the day you transmit the claim.
    • An exception report contains information about why specific vouchers within a claim were rejected, or why the refund Medicare issued differs from the amount claimed. It is also possible (although rare) for an entire claim to be rejected.
    • A payment report contains the amount of benefit paid by Medicare. If all the vouchers in a batch were rejected, there will not be a corresponding payment report. After you resolve the exceptions, that batch will no longer exist. Request reports via the Online Claiming window's Request Reports tab.
  11. Afterwards, you can compare payment reports with banking and exception reports to resolve any exceptions.
  12. (Optional) Normally payments are auto-receipted, however, there might be occasions where you must manually receipt a bulk payment.