Software as a Service Cloud Practice Management

Step-through GUIDE

Submit Quote Request

Successful Request

The results of a successful request are displayed on screen.

You can zoom-in to both the Quote details and the Service details as shown in steps (1) and (2),

You can print the Quote in the formal format for presentation to the patient. This report  includes the required Disclaimer and Privacy Notice.

Additionally - if there is an error or omission in the Quote - your go back and change the details - step (4) Change Quote Request Details - and re-submit the quote.

Zoom-in - Quote Status

Zoom-in - Service Details

Print Quote

Quote Types

There are four types of an OECW request: 

 OEC – Online Eligibility Check - Medicare and PHI checko Used by hospitals, day surgeries and medical providers to determine whether the patient is eligible for a selected presenting illness/condition on the admission date. It provides the out-of-pocket expenses for excess, exclusions and co-payments associated with the patient’s hospital product, and the Medicare and the private health insurer benefits payable for the medical services. 

 ECM - Eligibility Check Medicare - Medicare checko Used by hospitals, day surgeries and medical providers to determine whether Medicare covers the patient, and which Medicare benefits are payable for inpatient medical services. 

ECF - Eligibility Check Fund - PHI checko Used by hospitals and day surgeries to find out whether the patient is eligible for a selected presenting illness/condition on the admission date. This check provides the out-of-pocket expenses for excess, exclusions and co-payments associated with the patient’s hospital product. 

 ECO - Eligibility Check Overseas - PHI checko Used by hospitals and day surgeries to find out whether the patient who is an overseas visitor is eligible for a selected presenting illness/condition on the admission date. This check provides the out-of-pocket expenses for excess, exclusions and copayments associated with the patient’s hospital product.

[ECO is currently not available in SAAS Web]

Select the Quote Type from the drop-down list.

Note that there are a number of rules regarding data that must be provided which depends on the Quote Type. SAAS Web will alert you if there are missing data items or other inconsistencies.

Claim Types

Select from the available options in the drop-fown list.

AG = Agreement 

SC = Scheme 

MB = Billing Agent 

PC = Patient Claims

Note that the SAAS Web interface enforces rules reagrding dependant data items.

eg If the Quote Type is NOT OEC - Medicare and Fund - then the requirement for Claim Type will change (see example below)

When the Quote Type is Health fund Only

- the Claim Type entry point is not displayed.

Provider Details

When the Quote Type is Medicare

Medicare and Fund or

Medicare Only

- the Principal Provider is required.

Admission Dates

When the Quote Type includes Fund

Medicare and Fund or

Health Fund Only

- enter the (proposed) Date of Admission.

Compensation

The Compensation Claim Indicator must be supplied for Type Codes:

• OEC (Online Eligibility Check)
• ECF (Eligibility Check Fund)
• ECO (Eligibility Check Overseas)

Contact Details

Contact at claim submission site (contact at your Practice/Clinic) to be used should clarification about claim details be required.

These are optional (must be valid email address etc if entered).

This data is not stored anywhere other than the claim and can not be defaulted (must be entered each time0.

Presenting Illness

When a Presenting Illness is required - it must be  by entered either as :

• Presenting Illness Code (from the Private HealthCare Australia (PHI) code list (available in the drop-down list) - OR
• By using a Medicare Benefits Schedule (MBS) item number that indicates the presenting illness

Medical Events and Services - in more detail

Note the Medicare limits are that for each Claim - up to 16 Medical Events can be entered, and a maximum of 14 Services for each of those Events.

(A Medical Event and a Service is equivalent to an Invoice and an Invoice Item)

First - ensure that you have the correct Service Provider and the correct Date of Service.

For Quotes - the Date of Service can be a future date.

To start entering the Medical Events and Services for this Claim - click on New Medical Event.

MBS Billing Items

Selecting the MBS Billing Item from your customised Quick-Pick Items

Click on the Lookup Item icon if the item is not configured on your Quick-Pick list

You can change the Fee Level if you have multiple Fee Levels assigned for this item

- or you can click on the Enter Charge field - and type in the charge amount required.

Patient Quote IMC Service Details

The Edit Service Detail icon opens the Patient Quote IMC (In-Patient Medical Claim) Service Details screen.

The Service Details screen may be required  for MBS Item Additional Details or to enter Service Codes for non-MBS Items.(i.e. for Miscellaneous Items or for Prosthetic Device Items).

The MBS Item Additional Details are:

1. Number of Patients Seen
2. Field Quantity
3. Not Normal Aftercare
4. Restriction Override
5. Time Dependant Override

Service Code Types

Choose from:

• MBS Item Number
• Miscellaneous
• Prosthetic device code

Miscellaneous List

The Miscellaneous Item List is sourced from  the Private HealthCare Australia (PHA) website.

If you know the PHI Service Code - then you can enter this directly - or click on Miscellaneous Coding to display the list as shown.

When you click Save on the IMC Service Details screen - 

you will be returned to the billing/claim screen withe services screen with Miscellaneous service line completed.

Prostheses List (Department of Health)

The following table data for current prosthetic codes is sourced from the Department of Health (DoH) website

You can sort and search this table to look for the item.