Stage 10: Transmitting In Hospital Claims

Before you begin

Procedure

  1. Locate and select the invoice you completed the Day Surgery Episode for.
  2. Click

    You will be prompted that a Day Surgery episode must be completed. Click

  3. The New In Hospital Claiming (IHC) form appears. All relevant data from the Day Surgery Episode and MedicalDirector Bluechip is pre-populated on this form.
    • All fields marked in bold with * are mandatory.
    • Some fields are pre-populated. Check these fields to ensure the correct data is present.



  5. Once all information is completed press

    • If any required fields are missing you will be prompted to complete these before the claim will send.
    • The claim will now be submitted to the health fund via Medicare Australia.
  6. Once the Claim ID is generated; click

    at the bottom-right to continue the retrieval of processing and payment reports.
  7. Select Medicare Australia from the menu on the left side of the screen. The submitted claim appears at the top of the list, with a status of 'Awaiting Process Report'.

    Some claims may have a status of 'Awaiting Submission'. Claims with this status would have failed the Client Adaptor validation, and will have to be edited to ensure successful submission.

  8. Click

    to retrieve the processing report.
    • When the processing report is being retrieved, the response sent by the fund can be 'rejected' or 'interim' or 'final report'.
    • If the final processing report is available after the Transmit button is clicked, the Medicare Australia – Processing Claim(s) window appears, and the final Processing Report is downloaded. Final Report replaces Interim Report.
  9. After the final processing report is retrieved, the status of the claim changes to 'Awaiting Payment Report', and the claim can now be viewed by double-clicking it to see the result (Accepted/Rejected) of the claim submitted. The Processing report will consist of invoice details, and service item details of the retrieved claims, which may assist you with any troubleshooting.
  10. Click

    to download the payment report. The Medicare Australia – Processing Claim(s) window appears, and displays the downloading messages. You will be prompted that a Payment Report is available for download. Click

    to download the payment report.
  11. The downloaded Payment Report can be saved by clicking

    Alternatively, click

    to return to the Medicare Australia window. Payment report will consist of the summary of health fund payments which will help the practice reconcile payments with the bank statement. It also consists of additional payment details on the paid claim.

Results