Online Claiming for Medicare or DVA
Online claiming allows you to quickly submit claims to Medicare and DVA services.
To submit online claims, we use a pre-paid credit system - each successful transaction costs 1 Claiming Credit and you can combine multiple claims for a single client to reduce costs.
Credits can be purchased from Setup > Subscription > Claiming Credit.
Setting up Online Claiming
To begin using online claiming with Medicare or DVA, you will need to:
1. Go to Setup > Connections > Integrations).
2. Enable Medicare/DVA Online Claiming and click Configure.
3. Click Create Group at the bottom right corner, add a Name in the pop-up window and click Create Group. The Group will be set as Active by default.
Label the Group with the same name as your Location to avoid any confusion.
4. Click Add to add Providers to the Group.
5. Select the Provider and their appropriate Provider number in the list and click Add provider.
6. To add more Providers, click View Providers, then click Add Provider in the pop-up window and repeat step 5.
7. Once your online claiming is set up in your Nookal account, you will need to contact Medicare/DVA eBusiness on 1800 700 199 for the online claiming/banking form(s) relevant to your business.
Setting up a new online claiming integration? Ask your Medicare representative:
"I would like to set up Online Claiming for my business. We use software that submits claims via a centralised site certificate - I do not require a PKI Certificate. I need to set up banking details and also add my provider number(s) to a new Location ID. What forms do I need to complete?"
Generally, they will provide you with two forms:These forms may not suit your situation, so it's best to confirm with the Medicare representative.
- Online Claiming Banking Details - to connect your bank account details to the Location ID.
- Online Claiming Provider Agreement - to connect your provider number(s) to the Location ID.
8. Fill in the Medicare online claiming paperwork, make sure you include the Minor ID/Location ID to the Medicare Forms before submitting to be processed by Medicare.
You Minor ID/Location ID can be found in your Medicare setup (Practice>Integrations>Marketplace>Medicare), next to the name of the Group for the appropriate Location.
Once approved by Medicare, you are all set for Online Claiming.
Submitting an Online Claim
- To submit an online claim, you will need to ensure that each client has a Medicare and/or DVA number that has been saved and verified to their account (This is done from Clients > Health > Medicare/DVA)
- Online claims are added to a queue, and are generally processed overnight.
- To add a claim to the queue, you can either:
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- While generating a new invoice, tick the "Add to Medicare Queue" field.
- Open an existing invoice and click the Submit Online Claim button.
Bulk Bill vs Client Reimbursement
Claims are automatically marked as Client Reimbursement if there is at least one payment (of any value) on the invoice.
If there is no payment made on an invoice, the claim will be automatically marked as Bulk Bill.
Part Payment and Gap Payments
A client 'part payment' or 'gap' cannot be charged in addition to the amount claimed from Medicare. Bulk bill claiming must be submitted to Medicare for the final value of the service.
Cancelling an Online Claim
Claims can only be cancelled while they are in the queue to be processed - once processing begins, you will need to wait for Medicare / DVA to process the request.
To cancel a claim that has been placed in the queue, open the client's invoice, click the View Online Claim Status button, select the items to cancel, and click "submit".
Reviewing Online Claims
To see a list of the claims you have submitted for a specific period, simply visit Reports > Financials > Medicare and run the report for your chosen time period.
Remember: The status of each claim is generally updated overnight.
This information is correct at the time of writing. Always check with Medicare as to how your clinic should make its claims.