User Guides

and

Documentation

Document last updated on: 29/10/2019

Medicare Online Menu – SAAS Web 

Medicare Online Menu – SAAS Desktop

Medicare Configuration – SAAS Web 

Medicare Configuration – SAAS Desktop

Configuring HIC OnlineSettings

 Medicare Online Guide - SAAS Desktop


The MedicareOnline functions incorporated into SAAS Desktop Practice Management Systemare:-

     Bulk Bill (DBS)

     Department of Veterans Affairs PaperlessStreamlined (DVA)

     Patient Claims Interactive (PCI)

     Patient Claims Store and Forward (PCS)

     Online Patient Verification (OPV)

     Online Concession Entitlement Verification (OCV)

     Online Veteran Verification (OVV)

 

This User Guide gives an overview of the various methods of billing and claiming with Medicare Online using SAAS Medical Practice Management System.

Other documents:

Any usability or technical issues should in the first instance be directed to SAAS Medical Systems support.

If thereare no technical issues involved, any rejection of claims or other billing enquires should be directed to the Department of Human Services.

Billing and Claiming Methods SAAS Desktop

The Billing Mode

When billing with SAAS Medical, you are presented with 4 Billing Mode options:-

These can be set as Operator Defaults – but the mode can also be over-written during the billing process.

For normal operation, the practice will decide if they will use Real-Time or Batch(Bulk Bill) at the end of each day.

If you change the billing mode, you must understand how each mode operates.


Account Billing Type

 ForMedicare Online – there are only 3 valid Billing Type options:-

For each Invoice / Claim – the Patient must be assigned a Patient Account with the appropriate Billing Type. The patient can have several Patient Accounts, in which case care must be taken that the correct Patient Account has been selected.

Medicare Online Billing

Operator defaults must be set to Medicare Online Billing.

The Medicare Online Billing mode is required to beset for Direct Billing (BulkBilling) as well as for Patient Claim lodgments.

Medicare Online Billing refers to all Medicare Online billing processes e.g.:-

     Patient Claims (Interactive or Store and Forward

     Direct Bill Claims (Bulk Billing)

     DVAClaims

 

For Medicare Online Billing, the account type should be either Medicare or Veteran Affairs.

 

Billing for DVA should use a Veterans Affair account rather than Medicare.

 

Multiple Patient Accounts.

Several Patient accounts can be created as required. A patient may well have Private, Medicare, Veteran Affairs, and an Insurance account

Medicare Online Billing Mode is selected

Billing Item is entered - Continue

Interactive (Real Time is selected) – StartClaim Process

DB4 is previewed (or printed directly)

Confirmation of successful claim submission is displayed

Medicare Bulk Billing

Operator defaults must be set to Medicare Bulk Billing.

Creating and Submitting a Bulk Bill Claim


Creating a bulk bill claim is much like the same as a Patient Claim.  The only difference would only be the account selection.  In a Bulk Bill Claim, MEDICARE is the account type that should be used (see related image).   For some help regarding setting up account types see Settings related to HIC Online.

Medicare Batch Mode

Operator defaults must be set to Medicare Batch Mode.

Standard Billing Only

If theOperator defaults are set to Standard Billing Only, then only the standardinvoicing and receipting processes are available.

Medicare Online Menu – SAAS Desktop

 

Medicare URL’s                                                                                                                                                                                                               

  1. Medicare Online
  2. Medicare Online / ECLIPSE system status

If you experience any unusual connectivity problems, check the Medicare Online / ECLIPSE system status. 

If you have a connectivity problem, and everything at Medicare is Green , then contact SAAS Medical Systems support

Direct Billing

The Direct Billing Medicare menu provides options to:

     Transmit Stored Claims

     Retrieve Processing and Payments Reports

Select either Medicare Claims or DVA Claims:

Transmit Medicare Claims(Store and Forward)

Medicare Processing andPayments Reports and Receipting

Click onthe Clinic to Select the Clinic – then click Start Transmission to transmit to Medicare.

There are two kinds of reports available:

AProcessing Report -provides information relating to the claim and services within that claim.

APayment Report -details the payment (to be) deposited including the amount and bank accountdetails along with the list of claims covered by the payment

Bothreports can be requested (and re-requested) as required by the client system.

Thereports are available for 6 months after generation.

Note: When aProcessing report indicates a ClaimBenefitPaid = 0, apayment report for this claim will not be available. Attempting to retrieve onewill result in the CA returning a 2023.

Note: theProcessing reports send back service lines where there is a difference betweenthe benefit assigned and the benefit paid.

However,an explanation code is not set unless the benefit paid is 20c (or more) higherthan the benefit expected.

It issuggested that service lines included in the report without anexplanation code should be checked to see if the benefit paid differs from thatassigned, and if it does, the service should be treated in the same way asservices reported with a Medicare explanation code of 255.

Select the Claim

Either scroll though the displayed Claims – or use a search/find option that’s suits.

Direct Billing ProcessingReport

View Processing Report

Direct Bill Processing Report Display

Medicare – BatchReceipting and Reconciliation

Medicare Payment ReportSummary

Transmit DVA Claims(Store and Forward)

DVA Processing and Payment Reports and Receipting

DVA Batch Receipting and Reconciliation

DVA Payment Report Summary Receipting

Report not available

The report is not available yet or is no longer availablefor retrieval

The report is not available yet or is no longer availablefor retrieval

 

Reporting on DVA MedicalClaims

There are two kinds of reports available:

A Processing Report - provides information relating to the claim and services within that claim.

A Payment Report - details the payment to be deposited including the amount and bank account details along with the list of claims covered by the payment

Both reports can be requested (and re-requested) as required by the client system.

The reports are available for 6 months after generation.

Note: When a Processing report indicates a ClaimBenefitPaid = 0, a payment report for this claim will not be available. Attempting to retrieve one will result in the CA returning a 2023.

 

View Processing Report

DVA Medical Payment Report

View Payment Report

Patient Claims

The Direct Billing Medicare menu provides options to:

Transmit Patient Claims(Store and Forward)

 

Store and forward processing for HIC Online is to capture Claim data at the time of service, store the data and transmit it to the HIC at a later time convenient to the practice

Same Day Delete

The SameDay Delete screen will ONLY display Patient Claims submitted during the currentday. There are no selection parameters required.

Where an error is detectedin the details relating to a Patient Claim that has been processed in Real-Timemode after it has been completed, it is possible to request that that claim bedeleted.  The Same Day Delete Requestmust be sent from the same location as the initial claim and on the same day that the initial claim was lodged.

After a claim has been deleted, a new claim will besubmitted by the Location with the correct details supplied.

Where it is identified that Claim data wasincorrect, or incomplete, the Location must inform the Claimant.

Same Day Delete Claims only work on“successful” Claims.  Meaning the claimis NOT forced to be submitted to a Medicare operator (these claims areconsidered as store and forward).  Claimssubmitted to a Medicare operator are not shown in the SDD screen.

If the Claim was processed and sent to Medicare on a previous day, the claim cannot be deleted using the Same Day Delete facility. An adjustment to the original claim will need to be actioned by Medicare.  Data relating to the change must be provided to the Claimant so that they can validate the request for adjustment.
 
 

 

 

 

Reprint Statement ofClaim and Benefit Payment

Reprint Invoice

Reprint Lodgement Advice

Reprint Statement of Claim

Bulk Bill Claims and Patient Batched Claims

The Direct Billing Medicare menu provides options to:

     Batch and Transmit Medicare Bulk Bill Claims

     Batch and Transmit DVA Bulk Bill Claims

     Batch Patient Vouchers and transmit a claim.

The Processing and Payments Reports are:

     Medicare Bulk Billing Processing and Payments Reports and Receipting

     DVA Bulk Billing Processing and Payments Reports and Receipting

 

A Bulk Bill claim contains information about:

·        oneservicing Practitioner (and one payee where applicable);

·        one ormore vouchers (up to a maximum of 80); and

·        aconsistent service type eg. must be all in-hospital services or all out of hospital services.

Each voucher consists of:

  • a Patient;
  • one or more services (up to a maximum of 14); and
  • a Date of Service.

Claims must be transmitted daily whenever possible.

 

Batch and TransmitMedicare Bulk Bill Claims

 

Batch and Transmit DVABulk Bill Claims

Medicare Bulk Billing Processing and Payments Reports and Receipting
DVA Bulk Billing Processing and Payments Reports and Receipting
Batch Patient Vouchers and Transmit Claim

Click onany column that allows search/find (these are marked with the  symbol.

In the example above, it is searching by Direct Bill Claim Id = 313.

Note thatyou can also search Ascending or Descending on any column (marked with  symbol.

In this case (below) it is searching by Date Lodged :-