Submitting Online Claims for Medicare and DVA - Invoicing 2.0

Before you start...

1. Please note, this article relates to Medicare 2.0. If you have never made a Medicare/DVA claim through Nookal before, this option should be available by default. 

If you have made Medicare/DVA claims through Nookal before, these options will not be available until you Migrate to Medicare 2.0


  
2. Make sure the Medicare/DVA integration and your B2B Device have been set up, and the relevant forms have been sent to Medicare to link Provider numbers to the Minor ID, otherwise all claims will be rejected.

With Medicare 2.0, you will have access to a wider range of Claim Types for Medicare and DVA claims. 

To submit Successful Claims, in addition to an appropriate setup, it is important to: 

1. Ensure that each client has a Medicare and/or DVA number that has been saved and verified in the Health section of the Client's Profile. See Required Client Details for Medicare Claims for more information.
2. Attribute the invoice to the appropriate Case in which Medicare has been added as the Payer and the referring GP/provider number and referral date in the referral field. See Setting Up a Medicare EPC or CDM Case for all the details.

Online claims are added to a queue and are generally processed overnight. See the process below on how to submit these claims.

Important!

To submit Online Claims, we use a pre-paid credit system - each successful transaction costs 3 Credits (0.30¢ + GST AUD). 

You can combine multiple claims for a single client to reduce costs.

Credits can be purchased from Setup > Account > Billing > Credits.

Submitting an Online Claim at the Time of Invoicing

1. Click on Generate Invoice in the appointment screen.

2. Click Add to Medicare Queue.

3. Click on Save Invoice.

4. In the pop-up box that opens, ensure the Item Code and Claim amount are correct.

Important!

The Item Code needs to match the code provided by Medicare/DVA otherwise the claim will be rejected.

5. Select the appropriate Provider Number for the Provider that matches the Location or Claiming Group (Minor ID).

6. Tick the checkbox left to the Item(s) to be claimed.
 

7. Then press Submit Claim. 
 

8. In the claiming window, select a Claim Type. 

Claim Type will be one of the following:

•  Medicare Bulk Bill - For unpaid items, payment will be sent to the nominated practice bank account.
• Medicare Patient Paid - For paid items, the Client will receive the payment.
• DVA Allied Health and Community Nursing - For unpaid items, Payment will be sent to the nominated practice bank account.
• DVA Medical - For unpaid items, Payment will be sent to the nominated practice bank account.

Important!

1. Claims are automatically marked as Client Reimbursement if there is at least one payment (of any value) on the invoice.

2. If there is no payment made on an invoice, the claim will be automatically marked as Bulk Bill for Medicare claims.

3. Invoices will need to remain unpaid at the time of submitting the claim to be able to select and submit DVA claim types.

9. Select a Service Type.

Important!

Service Types will unlock depending on which Claim Type is selected in the Claiming window.

Service Type will be one of the following:

• S: Specialist - Available for Medicare Client Reimbursement Claims, Medicare Bulk Bill and DVA Medical Claims
   
• J: Allied - Available for DVA Allied Health and Community Nursing Claims
   
• P: Pathology - Available for Medicare Client Reimbursement Claims, Medicare Bulk Bill and DVA Medical Claims
   
• O: General - Available for Medicare Client Reimbursement Claims, Medicare Bulk Bill and DVA Medical Claims
   
• F: Community Nursing - Available for DVA Allied Health and Community Nursing Claims
   
• G: Dental- Available for DVA Allied Health and Community Nursing Claims
   
• L: Optical - Available for DVA Allied Health and Community Nursing Claims
   
• I: Speech pathology - Available for DVA Allied Health and Community Nursing Claims
   
• K: Psych - Available for DVA Allied Health and Community Nursing Claims
   

10. Select the Location for the claim.

Remember..

If the Claim was in a Hospital, select the In Hospital option, then you can set the facility that the Service was performed in:

See more info about Submitting In Hospital claims for Medicare and DVA here. 

11. Select the appropriate Referral or select No Referral Required (or one of the other options in the drop down) if no referral is required for the claim.
 

12. Click Submit.

The Claim has now been Submitted for processing by Medicare/DVA.

Claiming for an Existing Invoice

1. Find and open the Invoice.

2. Click Pay Via then Medicare Claiming.

3. On the pop-up window that opens, follow steps 4 onwards from the section above.

Cancelling an Online Claim

Claims can only be Cancelled while they are in a Queued status. Once processing begins, you will need to wait for Medicare or DVA to process the request.

To Cancel a Claim that has been placed in the queue:

1. Open the Invoice.

2. Click Pay Via then Medicare Claiming.

3. Navigate to the Claims tab.

4. Click the Cancel button to the right of the item.

Seeing the Status of Individual Claims

For each claim, you can select the Claims tab to see the history and status of claims for that invoice.

Here you will be able to see the status of your claims. This allows you to view and identify any issues that exist in your claims, such as claims in a Rejected, Expired or Error claim status. See more information on Medicare and DVA Error Messages.

You can also view the Status of all your Claims for Medicare and DVA in the Medicare Report via Reports > Financials > Medicare.

Remember...

The status of each claim is usually updated overnight.

Adding a Claimant

If you select the Medicare Client Reimbursement as the Claim Type, you are able to Add a Claimant to the claim. If you add a Claimant, then any reimbursement will go to the Claimant, rather than the client who received treatment.

Claimants are required for Clients 12 years or younger, regardless of the Claim Type. The Claimant must be added as a Client in Nookal in order to be selected as a Claimant on a Clients claim.

DVA Allied Health and Community Nursing Claims

When choosing DVA Allied Health and Community Nursing as the Claim Type, you can select Community Nursing as your Service Type. Here you can see a number of options that are exclusive to Community Nursing Type Claims.

You can add the Break in Care, allotted Hours of Nursing and the number of total Visits for each Nurse, as well as Admission and Discharge Dates for the Services rendered.

Same Day Delete

To Delete a Medicare claim on the day it was submitted, you need to:

1. Go to the Invoice.

2. Click Pay Via then Medicare Claiming.

3. Select the Claims tab.

4. Click on the Delete button.

5. Select a reason from the drop down. Then you can attempt to Delete the claim.

6. You will receive either a Successfully Deleted response, or if it was unable to be Deleted, the reason will be displayed to the user.

Medicare and DVA Claim Documentation

Once you have Successfully Submitted, or have a Completed Claim, you are able to generate the Claiming Voucher for your claim. At the bottom of the page you can see the Claiming Voucher button.

Clicking on this will generate the document that is relevant to that claim:

• Statement of Claim and Benefit
  • This document is provided to the Claimant when a Patient Claim has been lodged in real time, processed by the Agency and a Benefit amount returned to the Claimant.
• Lodgement advice
  • This document is provided to the Claimant when a Patient Claim has been lodged in real time, and has been Referred to an Agency Operator for action.

Important!

If you have Submitted more than one Claim for the same Invoice, you can generate a document per-claim, by going to the Claims Tab and clicking the Page Icon for each Claim.

This information is correct at the time of writing. Always check with Medicare as to how your clinic should make its claims.