Online Claiming
Order for Anaesthetic Items
The correct order for anaesthetic claims is as follows: Pre-op consultation item (17610 to 17690) Anaesthetic base item (20100-21997 or 22900–22905 if you're the anaesthetist, 25200 or 25205 if you’re the assistant anaesthetist, 22060 if you’re the ...
Claims for patients with only one name
Some patients are legally known by a single name. To submit an electronic claim in this situation, enter the name as the family name then enter the text "Onlyname" as the patient's first name. You should be able to verify and submit claims if the ...
Adding a Claimant for Child
Please see the short tutorial video below on how to add a Claimant in CESoft. Claimants are required for children under the of 14 years.
Assisting at Anaesthesia
To bill for an anaesthetist who assisted at a procedure use Item 25205 (for elective work) or 25200 (if patient is in imminent danger of death). See https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&qt=NoteID&q=TN.10.9 Also enter the start and ...
Medibank Private Short Stay contract arrangements
Some providers contract with Medibank Private to provide short-stay no-gap services for selected procedures, typically for joint replacements. See https://www.medibank.com.au/health-support/health-services/joint/ These services attract a higher ...
What is the Diagnostic Imaging Multiple Service Rule?
Diagnostic imaging items are subject to a multiple services rule. There are 3 rules, A, B and C, which may apply together. Rule A. If 2 or more diagnostic imaging services are provided to a patient on the same day, the fee for the second and ...
Registering providers with Medicare
Overview Before you can submit electronic claims, all providers must be registered with Medicare for online claiming. There are two ways to manage this. Via the provider's PRODA account, suitable for single providers or small numbers of providers ...
March 2020 MBS Update
From 1 March 2020 the Medicare Benefits Schedule (MBS) will be updated with the following changes: 2019-20 Budget measure to amend intensive care and emergency medicine MBS items Six new items for extracorporeal life support have been introduced and ...
What are the 1 November 2019 changes to MBS items
From 1 November 2019 the Medical Benefits Schedule will revise many of the items for anaesthesia. Both Cutting Edge and Access Anaesthesia have been updated to apply these changes on invoices with a date of service from 1 Nov. There are 28 amended ...
Overseas claims (OVS) including Overseas student health cover (OSHC), Overseas Visitors Health Cover (OVHC) and Reciprocal health care agreements (RHCA)
OVS - Overseas Claims Students from overseas on a temporary student visa are not usually eligible for a Medicare card. To comply with visa requirements, they may have to purchase Overseas Student Health Cover (OSHC) to meet the costs of medical and ...
Making adjustments to ECLIPSE claims
Once an ECLIPSE claim is submitted electronically, it is generally not possible to make adjustments electronically. Typical reasons for requiring adjustments may include changing date or place of service amending the fees charged adding services that ...
Online functions available in Cutting Edge
Cutting Edge software supports all the following functions Online Patient Verification PVF - Patient Verification Fund (Check the validity of patient membership details with a health fund) PVM - Patient Verification Medicare(Check the validity of ...
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 Electronic Bulk Bill claims allow you to claim the MBS ...
Claiming for newborns
An electronic claim can't be transmitted without a Medicare number for the individual receiving treatment. Claims for treatment of the infant can't be transmitted under a parent's Medicare number. If the infant doesn't have a card number the only ...
Finding the correct Health Fund code
From time to time you may need to search for a fund code. From the Databases > Funds page, click on search and enter the name or code you're looking for. This will give you a list of possible matches. Some funds have updated their names or codes. AHB ...
Billing Accurately Under Medicare
While the support staff at Cutting Edge are happy to provide general advice about how to correctly bill Medicare for medical services, it's the responsibility of the servicing provider to ensure that all services for their provider numbers are billed ...
How to report incorrect Medicare payments
It is the servicing provider's responsibility to advise Medicare if you are aware of incorrect Medicare payments, using the Voluntary acknowledgement of incorrect payments form ...
Dealing with Rejected Claims
From time to time electronic claims will be rejected. In this case they will appear on the Rejected Claims tab on the ECLIPSE page. The Invoice Status will also get changed to Follow Up, so you can easily locate rejected claims on the Follow Up tab ...
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 ...