CareRight Billing and Claiming Overview

• A location represents the financial entity you to group billing activities on
• You can use different locations for invoicing and the receipting of payments
• Each location has its own banking process.
• Locations are configured per business requirements and independent of Medicare claiming requirements

Service Locations

• A Location can have one or more Service Locations
• A Service Location represents the different locations that a provider provides services.
• A Service Locations may be external to the business running CareRight, for example, local public or private hospitals the doctor uses.
• Service Locations are mostly defined based on Medicare registration details for claiming purposes.

Accounts

• Accounts are the financial record for the relationship between a patient, a guarantor and the financial reporting provider.
• The account structure chosen affects reporting options.
• Accounts can be put on hold, sent to debt collectors and closed.

Provider

• The provider can be used in two ways for Billing.s the Provider on an account, called Financial Provider.
• As the Provider on an invoice called Service Provider.
• Financial Provider is used for reporting and account management based on business process.
• Service Provider is assigned to an invoice based on who did the work from a claiming perspective. (Controlled via Medicare/DVA etc.).

Guarantor

• The entity is responsible for paying an invoice.

• Can be:

  • Patient

  • Patient guardian/parent etc.

  • Medicare/DVA

  • Health Fund

  • Work Cover/Accident Authority.

  • Legal 3rd Party (e.g. Law Firm)

• Inbuilt smarts to manage claiming to Health Funds, Medicare, DVA following applicable rules.

• Claims to any third party can be managed in batch

Price

• Invoices must contain one or more Items.
• Items represent available goods and service that can be billed.
• Items can  be:
• MBS 
• Custom 
• Smartcode
• MBS Items know how the need to be claimed and interact with other MBS Items on the same invoice.
• Custom codes are user defined for billing non MBS Goods and Services.
• Smartcodes are special Items defined in the system for working with complex claiming scenarios easily like assistant billing or anaesthetist billing.
• Invoices know how to apply multiple procedure rule.
• Invoices handle management of gaps, excesses and copayments.

• Manual Invoice creation
• Automated billing using user defined workflows.
• Event capturing by providers to be translated to invoices using either of the above processes.

• Manual / Paper Based claiming supported.
• Batch generation
• Inhospital Claim (IHC) full HC21 form generation.
• Electronic Claiming Supported for:
• Medicare Bulk Billing
• DVA Paperless
• Inpatient Medical Claim (IMC)
• Inhospital Claim (IHC)

• Payments can be received as:
• Cash
• Cheque
• EFTPOS/credit Card
• Bank Transfer
• Payments are recorded as receipts
• Receipts can handle multiple payment types and monetary values on the one receipt.
• Receipts can pay off multiple Invoices
• Partial Payments are accepted.

• Pay down multiple invoices across multiple patients with one receipt.
• Partial paydowns allowed.
• Write On over payments easily with guided process.
• Write off under payments easily with guided process.

• Automated process pays down paid claims.
• No user intervention required on fully paid claims.
• Rejected claims handled allowing for resubmission after correction.
• Write On over payments easily with guided process.
• Write off under payments easily with guided process.

• Banking process per location to reconcile receipts with actuals.
• Guided process with dedicated printed forms for banking.
• Integrated security to prevent unauthorised alterations to banked receipts.