Resolving Claim Exceptions

Resolve exceptions to Medicare online claims.

About this task

Exceptions must be resolved for each Medicare online claim so that payment reports can be requested and the claims can be receipted. For example:

If three claims are paid on one payment report, all claims for that receipt must be resolved so receipting can occur.
If Single Claim Receipting is set in the Online Claiming tab of Global Settings, the remaining two claims will receipt-off automatically.

Tip:

To ensure claims are receipted, resolve the exceptions in the same session as you request the report from Medicare. If you resolve some exceptions, close the Resolving Claim Exceptions window, and then resolve more exceptions, the payment report is not printed and the claims are not receipted. In this case, to print the payment report and issue receipts, request the report from Medicare again and resolve or accept all of the exceptions.

Procedure

To resolve exceptions to Medicare online claims:

If the Medicare Australia Online Claiming window is not displayed, from the Pracsoft Waiting Room, select Processing > Online Claiming.

Tip:
If your practice uses Medicare Easyclaim, click Online Easyclaim Claiming instead of Online Claiming.
In the Medicare Australia Online Claiming/Easyclaim Reconciliation window, click 5 Request Reports.
Click Request. The Request Claim Reports from Medicare Australia window displays a list of processing reports or payment reports that Medicare has for your practice.
In the Request Claim Reports from Medicare Australia window, in the List of Claims list, select the claims you want to work with.
Click Request. Pracsoft downloads the selected processing reports from Medicare. These reports might contain claim exceptions. New processing reports will open automatically upon being downloaded from Medicare.
Click Close.
To resolve exceptions listed in the Request Reports window, click Resolve.
In the Resolving Claim Exceptions window, in the Claims to resolve list, select a claim. The exceptions for that claim are displayed in the Exceptions to resolve list.
Tip:
- If any payment has been made on a claim, you must accept the exception. You can't edit and resubmit it. If the payment is incorrect, contact Medicare to correct the discrepancy.
- If you accept a voucher with a $0 payment, Pracsoft assumes the visit record is a mistake and reverses it, retaining the details as a hidden entry. It is not possible to restore the visit record so, if the billing is still needed, recreate it by adding the patient to the Waiting Room and entering the visit details again. To see the visit details, go to the patient record Accounts tab and set Show Hidden Entries. The visit record in Clinical is not affected.
- Any items with a $0 payment need to be billed again.
In the Exceptions to resolve list:
- To accept an exception, select it. Click Accept > Yes.
- To accept all exceptions, click Select All > Accept > Yes.
- To edit and resubmit the claim, click Resubmit/Edit.
  1. Optionally, in the Verify Resubmit and Edit Voucher window, enter a comment.
    Tip:
    Comments are not sent to Medicare when you resubmit the claim.
  2. Click Yes.
  3. In the Edit Visit from Claim window, make the changes needed to resolve the exception.
  4. Click Voucher.
  5. Click Close.
  6. In the Resolving Claim Exceptions window, click Resubmit/Edit to remove the voucher from the claim. The voucher can be edited and batched in a subsequent claim.
Continue accepting or resolving the claim exceptions.
Click Close when all exceptions are accepted or resolved.

Results

When all exceptions are resolved and the Resolve Exception window is closed, Pracsoft automatically requests the payment report and receipts the claim.