Types of Online Claims

Types of Online Claims

The Health Fund you've selected on an invoice will dictate which claim type (Medicare, DVA or Private Health) is used. This also sets the Fee Calculation to the correct value.

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
      The characteristics of Bulk Bill claims are
  1. you cannot charge any out of pocket expenses
  2. payment goes directly to the provider's nominated bank account, usually overnight
See this Medicare webpage for more details

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
    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
      The characteristics of this claim type are
  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.
See this Medicare webpage for details on Medicare claims

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 visible this fund doesn't accept electronic 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

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