Dealing with Part Paid claims

Dealing with Part Paid claims

From time to time electronic claims may only be paid in part. The Invoice Status will be Part Paid, so you can easily locate them on the Part Paid tab in the Invoices listing page. The resolution depends on the cause of the part payment. Here are some tips to assist you in resolving these.

Firstly, check the History tab on the invoice, it will have more details about the part payment. Check if all items were part paid, or only certain items.

Have all items have been paid at a lower rate?
This can happen when the incorrect fee schedule was used to submit the claim, resulting in a higher fee on each item. For example, some funds have plans that pay at different rates. Cutting Edge has no means of knowing which plan a patient is on. In most cases you would've been prompted when selecting such a fund to check the patient's plan.
Another possible cause is with BUPA who pay some categories of providers at MBS rates rather than their scheduled rate. In these cases it is not possible to resubmit the invoices electronically, if you feel the underpayment is in error you will need to contact the fund.

Have some items have not been paid at all?
Where there are several items on an invoice, it's possible that some have been paid and others have been rejected. You can determine this and the reasons for rejection from the details on the History tab. If the rejected items is affected by the other items on the invoice (i.e it's a derived item like an after hours benefit, or part of a multiple operation) then you can't resubmit it electronically.

In the case where the rejected item is unaffected by other items on the invoice, first correct the cause of the rejection.  To resubmit a claim:
  1. Click on the DUP button at the top of the invoice to create a new invoice for the same patient, and add only the items you want to resubmit. For neatness, you can remove the rejected items from the initial invoice and change its status to Fully Paid.
  2. Sometimes rejections can't be sorted out electronically, and in this case you'll have to contact the fund by phone or post.

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