Claim Lifecycle
Claim life cycle management via Invoices and Claims
| Step | Viewable via | Criteria | |
| Admission (discharged) | Uninvoiced | No invoice has been raised | |
| Invoice raised | Unsent | No claim has been successfully sent | |
| Claim prepared | Unsent | No claim has been successfully sent | |
| Claim sent/submitted | Unpaid | No payment have been received | |
| Rejected | Problem | The payee has rejected the claim with feedback. | |
| Paid | All Status | ||
| Part Paid | Part Paid | ||
| Overpaid | Part Paid |
Overview:
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Claim information - statuses
When viewing a specific invoice, you will often see a more detailed Claim Information break down.
It lists a number of more fine grained statuses as per the table below.
| Status | Description |
| Warning | The invoice has been successfully sent to Medicare. Medicare has reported some patient data in the claim is outdated, but it won't affect the payment of the claim. |
| Successful | The invoice has been successfully sent to Medicare. |
| Referred | The claim needs to be referred to a Medicare Customer Services Officer for further assessment. The claim will be processed and payment notification will be sent in the near future. |
| Processed | A PCI claim has been accepted by Medicare and payment will be made. |
| Pending Acceptance | A PCI Claim has been lodged with Medicare, but it has not been processed. |
| With Medicare | An IMC claim has been sent via Medicare, no errors were reported by the checks that Medicare performs and no updates have been received from the receiving agency. |
| Rejected | Medicare has rejected the claim. |
| Rejected by Fund | The Health Fund has received the claim and has rejected it. |
| Completed | All processing by Medicare is complete including any payments that need to be made. |
| Problem | The claim has been only partially paid because of a problem with Medicare. |
| Eligible for In-hospital Claim | Eligible for In-hospital Claim, though one has not been created yet. |
| Incomplete Claim | An IHC claim has been created but has not been prepared for submission. |
| Submitted | An IHC claim has been submitted. |
| Waiting for Submission | An IHC claim has been prepared but has not yet been submitted. |
| Eligible for Inpatient Medical Claim | Eligible for Inpatient Medical Claim, but a claim has not been submitted. |
| Billed | Same as Raised. Legacy status not used in CareRight, but may exist in data migrated from The Specialist. |
| Raised | An invoice has been created, but no claim created. |
| Sent | Sent as part of a batch. |
| Paid | The total amount of the invoice has been paid. |
| Reversed | The invoice has been reversed. |
