There are a number of reasons why a Medicare or DVA claim may be rejected when submitting Online Claims through the Medicare Online Claiming system.
The most common reasons for rejected claims are:
The service has already been paid under a previous Medicare/DVA claim.
Maximum number of services has already been paid for the patient (eg. Medicare EPC).
The submitted patient Medicare/DVA details do not match Medicare/DVA records.
Incorrect Item Code attached to the claim.
The practitioner providing the service has not been properly registered for online claiming, or has not been registered to submit online claims from that location.
Missing information necessary to claim (eg. referring doctor provider number, date of referral or details of the injury treated for DVA white card holders).
In the event a claim has not been successful or has not returned a valid report from Medicare/DVA, the following steps will allow you to resubmit the claim.
Step 1 – Locating the claim
Go to the System menu and select Medicare/DVA Claims.
You will now need to locate the unsuccessful claim. The claim will normally be listed under the 'Incomplete' or 'Failed' status. If you are having difficulty locating the claim, select the 'All' option to display all claims regardless of status and ensure the date range selected is appropriate.
The claim number can be matched against the transaction listing within the patient's file to ensure you have the correct claim selected.
From the Medicare/DVA Claims window, highlight the unsuccessful claim and click Reports. This will attempt to retrieve a report directly from Medicare or DVA with information on the claim status.
The 'Medicare Explanation Code' is retrieved directly from Medicare/DVA and provides basic information on the claim status. If you require further information on explanation code interpretation please contact Medicare Online Claiming support on 1800 700 199.
In the event no report is available and two business days have passed, contact Medicare support to confirm the claim has been received.
If the claim was not received correctly, confirm that the practitioner is correctly registered for Medicare Online Claiming before resubmitting.
After determining the cause of the unsuccessful claim, correct the error(s) in the patient file using the information provided by the explanation code and Medicare or DVA. Once the error has been corrected, you are now ready to resubmit the claim.
Step 2 – Resubmitting the claim
If the claim requires resubmission, the existing claim will first need to be deleted before a new claim may be submitted using the original transaction.
Locate and highlight the claim within Medicare/DVA Claims, and select Delete.
It is recommended that you contact Medicare/DVA to confirm resubmission is the correct course of action before resubmitting the claim. Please note if Medicare/DVA delete the claim from their system, you will no longer be able to delete the claim using Front Desk. If necessary, it is important that the claim is deleted within Front Desk first, before being removed by Medicare/DVA.
Once the claim has been deleted from the Medicare/DVA Claims window, it can be resubmitted from the Patient File using the existing transaction. Open the patient file, and select Transactions.
Right-click the appropriate transaction and select 'Medicare Online', followed by the type of claim to be submitted (Patient Claim, Medicare BB or DVA).
Complete the Medicare/DVA claiming wizard to resubmit the claim using the corrected information.
Congratulations! You have successfully resubmitted a Medicare/DVA claim.
After waiting 24-48 hours you can then process the claim to ensure it was successful.