Overview
CareRight supports claiming for three different kinds of categories
| Categories | Claims |
| 1. Medical Specialist | Bulk Billed PCI(Patient Claim Interactive) IMC(Inpatient medical Claim) |
| 2. Day Hospital | Bulk Billed PCI(Patient Claim Interactive) IMC(Inpatient medical Claim) IHC(CR/Eclipse) |
| 3. Day Hospital with Long Stay | Bulk Billed PCI(Patient Claim Interactive) IMC(Inpatient medical Claim) IHC(either CR/Eclipse or Thelma/ Eclipse) |
1. Types of Claim
| Claim Type | Scenario | Claim Process | Claim Channel |
| Bulk Billing (Medicare & DVA) | Claim between patient and Medicare from a Medicare/DVA Account. | Medicare Online | To Medicare/DVA Via Eclipse/Manual |
| PCI (Patient Claims Interactive) | Claim between Patient and Medicare from a private account against the Outpatient Location. | There are two different ways of handling PCI Claim in CareRight. 1. Patient pay in advance, CareRight generates the PCI Claimfrom the invoice paid, Patient gets reimbursed from Medicare in a few Hrs. 2. The patient does not pay in advance, CareRight generates PCI Claim, the patient gets a check from Medicare, the patient then needs to return the check into Practice. Both these process are via Eclipse | To Medicare Via Eclipse |
| IMC (Inpatient Medical Claims) | Claim between, Patient, Health fund, and Medical Provider in an Inpatient location against the Private Health fund account. | Claims for provider services during surgery. | To Health funds Via Eclipse |
IHC (In-hospital Claims) | Claim for Day stay | Claims for day stay in-hospital admissions | Health fund/ DVA Via;
|
| Claim for Multi stay | Claims for multiday Psychiatric admissions. Please Note: CareRight supports Multiday billing and Claiming only for Psychiatric Hospitals. | Health fund/ DVA Via;
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2. Claim Payment Methods
- Manual Batch Payments
- Pay down multiple invoices across multiple patients with one receipt.
- Partial pay downs allowed.
- Write On over payments easily with a guided process.
- Write off underpayments easily with a guided process.
- Invoices displayed and segregated based on historical (used to be in batch) and current (used in batch) status.
- Automated Claim Payments
- The 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 a guided process.
- Write off underpayments easily with a guided process.
3. Setup
There are some mandatory configurations to be set up in CareRight for the successful processing of each of the above-mentioned Claims.
Please refer to Claim Configurations (PCI, IMC, IHC, and Bulk Bill) in System Admin Guide for more information.
