Bulk Bill Claims

1. Electronic Bulk Bill claims allow you to claim the MBS rebate amount for consultations and procedures without the need for paper submissions, with payment directly to the provider.
   
2. You can only charge the rebatable amount, out of pocket amounts are in breach of Medicare legislation - when you select Bulk Bill on the Account To tab, Cutting Edge will calculate the correct fee for your items
   
1. 75% of the MBS fee for in-hospital
   
2. 85% of the MBS fee for out-of-hospital
   
3. 100% for certain designated items
   
3. Click the Submit Now button
   
4. Print a DB4 form if required. This is also stored as a PDF in the invoice's History tab, even if you don't print it at the time.
   
5. Payment goes directly to the provider's bank account, and Medicare Online returns a payment advice to the software
   

1. you cannot charge any out of pocket expenses
   
2. payment goes directly to the provider's nominated bank account, usually overnight
   
3. NOTE: Bulk Bill Claims can only be submitted within 24 months of the date of service. 

Medicare Claims

1. Medicare Claims are the equivalent of a patient submitting your printed invoice at a Medicare office.
   
2. Patients must give their permission (verbally) for you to submit a Medicare claim.
   
3. On the Account To tab, Select Medicare Claim
   
4. If the patient is paying any up front amount, record the payment in CE before submitting.
   
5. Click the Submit Now button.
   There are three possible responses at this point, displayed to you in a window.
1. ACCEPTED - claim has been assessed and will be paid.
   
2. REJEC​TED - claim has been assessed and rejected, see the report for reasons.
   
3. MEDICARE_PENDABLE - claim needs to be assessed by a human operator. In this scenario you will see a "Continue" button in the header of the window. Review the interim assessment and if you would like to submit it to an operator click on the "Continue" button, otherwise close the window to abandon the claim. If you change you mind in the next 60 minutes you can re-open the assessment from the History tab on the invoice and click 'Continue". After 1 hour the claim is abandoned and you will need to submit a fresh claim.
   
6. Please note
   
1. For fully paid claims the payment goes to the patient
   
2. For other claims payment is a cheque to the doctor, via the patient, which means your payment will be delayed. Medicare claim rebates are never paid directly to your account (unlike Bulk Bill claims, see above).
   

1. you can charge an out of pocket expense
   
2. you save the patient the trouble of submitting the claim
   
3. you ensure that the claim is in the system without any action required by the patient
   
4. if the patient forgets to send you the cheque, Medicare can cancel it and deposit to your account.
   
5. NOTE: Since mid 2024, Medicare Claims can only be submitted electronically within 6 months of the date of service. Beyond that you'll need to send the claim to the patient so they may make a claim.

DVA Claims

1. You can also submit DVA streamlined, paperless claims 
   
2. The software will verify the DVA details (Medicare details aren't required for claiming and can be optionally entered if desired)
   
3. Gold Cards - all claims accepted
   
4. White Cards - only claims for specified conditions will be accepted
   
5. The process is exactly the same as a Bulk Bill claim - On the Account To tab, Select DVA Claim
   
6. Click the Submit Now button
   
7. The software will let you print a voucher for the patient This is also stored as a PDF in the invoice's History tab, even if you don't print it at the time.
   

Inpatient Claims

1. Known as IMC (Inpatient Medical Claims) this claim type is used to send claims to health funds.
   
2. Cutting Edge will verify the patient's Medicare and Funds details. You need to resolve any verification errors before you can send a claim.
   
3. To submit the claim, in the Account Handling box change Account To to Inpatient Claim if necessary, then click the Submit Now button
   
4. Note: If Inpatient Claim is not a visible option this fund doesn't accept electronic IMC claims, 
   
5. If the Submit Now button is not visible 
   
1. You haven't selected an electronic claim type in the Account handling box, or
   
2. The invoice status is not set to Queued, or
   
3. There are no items on the invoice
   
6. NOTE: IMCs can only be submitted within 24 months of the date of service. 

Overseas Claims

1. Known as OVS (Overseas Medical Claims) this claim type is used to send claims to health funds where a patient is a visitor or international student who is required to take out health cover.
   
2. There are no Medicare details. Cutting Edge will verify the patient's Funds details. You need to resolve any verification errors before you can send a claim.
   
3. To submit the claim, in the Account Handling box change Account To to Overseas Claim if necessary, then click the Submit Now button
   
4. Note: If Overseas Claim is not a visible option this fund doesn't accept electronic OVS claims, 
   
5. If the Submit Now button is not visible 
   
1. You haven't selected an electronic claim type in the Account handling box, or
   
2. The invoice status is not set to Queued, or
   
3. There are no items on the invoice
   
6. NOTE: OVS claims can only be submitted within 24 months of the date of service.