How to manage claims with Exceptions or Rejections (Bulk Bill/DVA/ECLIPSE)

Brief Overview

Clinic to Cloud would like to introduce a streamlined approach to manage and claim Bulk Bill, DVA and Health Fund invoices. 

The option to create a Exception or Rejected claim from the Exceptions tab found in Claiming.

When an invoice is complete and it is time to claim, a Submit option will mark this invoice with a Ready status to be automatically claimed at 1:00am AEST daily. 

A response will be available after each invoice is transmitted to Medicare/ECLIPSE

The Short Version

  • The Exceptions tab is available to manage claims with Medicare/ECLIPSE errors, rejections or part payments.
  • Exception or Rejected claims are available with error codes and details from Medicare/ECLIPSE
  • Edit allows the option to edit items with zero paid amounts
  • View will be available to review this invoice if items are part paid or related to the Multiple Procedure Rule (MPR) and no edits can be made on this invoice 
  • Allow Manual Payment, paid manually? add the manual payment and finalise the invoice
  • Accept and Balance, write off the outstanding balance and move to finalised 
  • Export this tab to excel 

Instructions 

1. Go to Claiming, Is this a Medicare, DVA or Health Fund/ECLIPSE claim?

If Medicare or DVA, select to Medicare

If Health Fund/ECLIPSE, select ECLIPSE

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2. Go to the Exceptions tab 

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3.  There are two status types that will display in Exceptions 

Exception status, means there will be error/s to action or part payment has been received

Rejected status, mean the entire claim has been rejected and there will be error/s to action

Medicare/ECLIPSE errors could display on each item or the invoice as a whole. drop down the invoice to show more details on each item number.
Tip Hover over the error for more information

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4. Manage claims with the relevant actions based on the status. 

  • Edit allows the option to edit invoices with unpaid items and remove items that have been rejected or not required on this claim.

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  • View will be available to open the invoice in read only. If items are part paid or related to the Multiple Procedure Rule (MPR) and no edits can be made. 

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5. Export this tab to excel 

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