Batch Claims Overview

Overview

CareRight is capable of sending bulk claims, this includes;

• Medicare online claiming (except IHC Claims);
• DVA online claiming; and,
• Paper-based health fund claiming (except IHC Calims).

View Claims

The status of claims can be viewed for an entire location:

1. Click on Location and search location, click Show.
2. Click on Batch Claims > select Show.

 Reviewing Claims

1. From the Dashboard.
2. Select Locations.
3. Select relevant Location by Clicking Show.
4. Select Batch Claims from the left-hand menu.
   1. A list of invoices attached to the batch appears. These are segregated by historical invoices (used to be in the batch) and current invoices.
5. Click on Online Batch Claims.
   1. You will see Online Batches and their status (Raised, Sent, Processed, Problem). Paid batches will move to ‘Archive’.
6. Click Create Batch Claim – this will add any raised DVA / Bulk Bill invoices to new batches.
   1. All raised invoices will now be created in Batches by provider and Type (DVA or Medicare).
7. Send each Batch when ready.
8. Providers are required to declare: If password based user, the provider will be asked to enter their CareRight password. All other authentication methods rely on a one-click declaration and click Send.
   1. You will receive a message of whether the batch has been sent successfully or unsuccessfully with the error message of what to fix.
9. You can now return to the Location> Batch Claims> Online Batches screen to review status.
   1. NOTE: CareRight will fetch processing reports daily and update the status

Batch Information Panel

When viewing a batch, an information panel appears that conveys the following information:

• Batch Number
• Batch Date
• Batch To
• Batch Status
• Batch Price
• Benefits Paid
• Payments Received
• Medical Provider
• Location 
• Audit Id

Batch Payment Amount Column

The Medicare Batch Payment Reports panel now features a Batch Payment Amount column that displays the amount of the batch payment that was specifically for the batch being viewed.

Batch Status

Batches can have the following states:

• Raised
• Sent
• Failed
• Problem
• Paid

When a batch is created it is made in the Raised state. When a batch is sent to Medicare it it placed in the Sent state (Note: Manual batches do not get placed in a Sent Status).

The Current location Online Batch Claims screen shows:

• Raised
• Problem
• Failed
• Sent

The Archive location Online Batch Claims screen shows:

• Paid batches
• An Online batch Return

When Medicare have assessed a batch they will provide a processing report detailing how a claim will be paid. If no payment will be made, the batch is put in the Problem state. If a payment is due, the batch is left in the Sent state until a payment has been made. Once a payment has been made, then a batch is automatically paid down. If batch is paid in full, then batch is marked as Paid. If only a partial payment has been made then the batch is marked as Problem.

When there is a manual Batch return:

When a payment is manually processed a batch will be placed in a Paid status if all invoices in batch are paid in full. If an invoice is unpaid or partly paid, then it will be placed into a Problem status.

Note that when a patient passes away, claims cannot be sent electronically. In these scenarios, claims are automatically excluded from electronic batches and need to be performed manually.

Important Note: If you send a batch claim to medicare you must wait for a medicare response. If you don't get a response then you should follow it up with Medicare before acting on the issue and finalising the batch. Finalising a batch can cause data errors, payments to not reconcile etc.

Handling batches where no successful processing report is retrieved:

Batches will automatically be classified as failed when:

• When a batch is in Raised status;
• Has a valid claim submission; and,
• No processing report after 10 days.

An error message will appear as follows:

Finalising a batch:

Finalising a batch allows users to add adjustments to any partially paid invoices making up the difference between charge and payment. Any invoices that have a $0 payment are removed from the batch allowing them to be re-batched. 

The batch is then marked as Paid if all invoices in batch are fully paid with adjustments. The batch is marked as Problem if any invoice has not been adjusted leaving any invoice partially paid.

Invoice Claims screen:

The Invoice claims screen groups invoices in the following statuses:

• Unsent
• Part paid
• Problem
• Unpaid

If an invoice has been added to a batch and is either a manual batch or a Medicare batch—and has not been sent via Medicare online—then the invoice is marked as Unsent.

If an invoice has been updated by a online batch return with a Medicare online error,the invoice will be marked as Problem.

If an invoice has been been paid, it is not included on invoice claims screen.

If invoice is part of a batch and has only been partially paid, it is marked as Part paid if it does not have a Medicare online error.

If invoice is part of a batch and is not (unsent, part paid, problem or paid), then it is marked as Unpaid.

Medicare Online Request History

Displays a list of all requests made along with relevant information, such as: 

1. Request ID;
2. Date;
3. Request Type; and,
4. Status.

Viewing Batch Report Details

In the Batch Account Screen, if there is an associated payment report, then the Medicare Batch Payment Reports panel will appear. Click Show to view report details.

Medicare bulk claim

1. From CareRight Dashboard.
2. Select Locations from menu.
3. Select relevant location and select Show.
4. Select Batch claims.
5. Create batch claims.
6. Raised Batches.
7. Click Send.
8. Enter password (same as CareRight log in)
9. Errors will have a message and the error highlighted in Red.
10. 1 – 2 working days, pay down, appear on patient record.

This screen will provide a summary of the locations Online Claims and Manual Claims.

Permissions

Only users with the permission to edit batches and claims will be able to perform functions in this area of CareRight.

A special permission called "Can override claim processing" is available when a batch needs to be finalised after a claim is sent. Sometimes a claim can be successfully submitted, but no processing report or payment report is provided. Payment for the claim may be manually arranged with Medicare or DVA. If a user has this permission then they will be able to override the normal flow of batch processing and finalise the batch at anytime. You must not do this without confirming with Medicare or DVA the status of the batch claim.

Users with the "Can override claim processing" permissions are locked out from making changes that result in batch payments failing to apply. Without this safeguard, users who submit a claim and then finalise a batch before receiving a response from Medicare would inadvertently cause an error in the automatic paydown of batches.

If the claim is in a Timed Out status, and over 12 hours old, then an information panel will appear at the bottom of the Batch Claim screen enabling users to mark the claim as Failed:

When Mark Claim as Failed is clicked, the claim status will be changed to Failed.

Backdating a Transaction

If a user has the appropriate permissions to edit account transactions, then they can modify individual transaction dates. After clicking Allocate, an option (checkbox) to backdate transaction history will appear. When selected, a mini-calendar appears enabling the user to select a different transaction date.

Batch Claims > Easier technical support from Services Australia

In some cases, a medicare payment or processing report is simply not provided by Medicare. Often, this is due to misconfiguration with Medicare - a provider's details are wrong or incomplete. 

To make it easier to submit questions to Medicare, we've made a one click draft email generator, to help customers and Medicare quickly get to the bottom of issues.