Easyclaim Workflow

Fully Paid/Patient Paid Claims

For an approved patient paid claim:

• Consultation details are entered into invoice screen in PMS.
• Payment is taken from the patient – either via integrated EFTPOS or another method – cash, cheque etc.
• After payment, the patient can choose how they would like their rebate, eg:
  • Direct Deposit: If they have registered their bank details with Medicare, they could be paid by direct deposit from Medicare (after 1-3 days)
  • Cheque: They could have a cheque sent out to them from Medicare
  • Go to Medicare Office: They could ask for the invoice and take it to Medicare for their rebate
  • Swipe Debit Card (Easyclaim): Or they could swipe a debit card through the Tyro terminal and have the rebate in 11 seconds (no need to register bank details)
• If the EFTPOS Card/Easyclaim option is selected, practice staff would press one button in the PMS and all the claim information is send through to Medicare, including the item numbers, date of service, doctor provider number, patient’s Medicare card number (and claimant if applicable)
• A response comes back from Medicare approving the claim:
  • The EFTPOS terminal screen will read “Claim approved. Benefit $XX.XX. Swipe EFTPOS card”
  • The terminal window in the PMS will mirror this message.
  • The patient swipes their debit card, selects their account and enters their pin.
  • The Tyro terminal prints an official Medicare receipt.
  • A window should appear in the PMS letting Practice staff know the details of the transaction, eg. that the claim was approved, the cost of the consultation, the amount that was paid by the patient, the amount that was rebated to the patient.
  • The Medicare rebate is paid back into the patient’s bank account in 11 seconds.
  • The normal invoice printed through PMS is optional – users might opt to ‘save’ this rather than printing it.

For a rejected patient paid claim:

• Consultation details are entered into invoice screen in PMS
• Payment is taken from the patient – either via integrated EFTPOS or another method – cash, cheque etc.
• After payment, the patient can choose how they would like their rebate, eg:
  • Direct Deposit: If they have registered their bank details with Medicare, they could be paid by direct deposit from Medicare (after 1-3 days)
  • Cheque: They could have a cheque sent out to them from Medicare
  • Go to Medicare Office: They could ask for the invoice and take it to Medicare for their rebate
  • Swipe Debit Card: Or they could swipe a debit card through the Tyro terminal and have the rebate in 11 seconds (no need to register bank details)
• If the EFTPOS Card/Easyclaim option is selected, practice staff would press one button in the PMS and all the claim information is send through to Medicare, including the item numbers, date of service, doctor provider number, patient’s Medicare card number (and claimant if applicable)
• A response comes back from Medicare rejecting the claim:
  • The EFTPOS terminal screen will read “NO BENEFIT PAYABLE”
  • A receipt will print from the EFTPOS terminal explaining no benefit was paid.
  • A message should appear in the PMS showing both the error code and a description of the error code. Eg “9632: Duplicate Service already paid. If not duplicate, resubmit with appropriate indication”.
• Depending on both the rejection code and how PMS/Tyro choose to implement this, practice staff may be prompted to print a normal invoice and ask their patient to go to Medicare, or the workflow might allow the practice to attempt to resubmit the claim.

Part Paid Claims

For an approved Part Paid claim:

• Consultation details are entered into invoice screen in PMS
• Payment is taken from the patient for the ‘Gap’ – either via integrated EFTPOS or another method – cash, cheque etc.
• After payment, the ‘Cheque’ option is the only available rebate option via Easyclaim (for a cheque to be sent to the patient that is made out to the Doctor).
• Practice staff would press one button in the PMS and the claim is transmitted in real-time to Medicare Australia.
• A response comes back into the PMS explaining that the claim has been approved.
• A ‘Lodgement’ receipt is printed from the Tyro EFTPOS device explaining that the claim was approved.
• A window should appear in the PMS letting Practice staff know the details of the transaction, eg. that the claim was approved, the cost of the consultation, the amount that was paid by the patient, the amount that was rebated to the patient.
• The option to print a customer copy appears in the PMS.

For a rejected Part Paid claim:

• Consultation details are entered into invoice screen in PMS
• Payment is taken from the patient for the ‘Gap’ – either via integrated EFTPOS or another method – cash, cheque etc.
• After payment, the ‘Cheque’ option is the only available rebate option via Easyclaim (for a cheque to be sent to the patient that is made out to the Doctor).
• Practice staff would press one button in the PMS and the claim is transmitted in real-time to Medicare Australia.
• A response comes back into the PMS saying ‘No Benefit Payable’, this message will also appear on the EFTPOS screen.
• A ‘Lodgement Receipt’ is printed from the Tyro EFTPOS device explaining that “Medicare has assessed that no benefit it payable”.
• A message should appear in the PMS showing both the error code and a description of the error code. Eg “9632: Duplicate Service already paid. If not duplicate, resubmit with appropriate indication”.
• The option to print a customer copy appears in the PMS.

Unpaid Claims

For an Unpaid Claim

• Patient invoice details are entered into PMS
• The option to pay at another time would be selected.
• The rebate window appears - the only rebate option is ‘Cheque’ (meaning a cheque will be sent to the patient, but it will be made out to the Doctor).
• Once this claim is transmitted, all of the Medicare claim information is sent through to Medicare and Medicare will approve the PDVC claim in real time.
• An official Medicare receipt is printed, explaining that the claim has been lodged with Medicare in real time.
• Medicare will then post a cheque out to the patient
• The patient brings this cheque back into the surgery and usually makes a payment at the same time

Bulk Billed Claims

For an approved Bulk Billed claim:

• Consultation details are entered into invoice screen in PMS
• The claim is transmitted in real time to Medicare Australia
• A response will come back to the PMS asking “Do you accept the claim for $XX.XX?” This question prompts practice staff to check to make sure that the number looks correct. If it doesn’t look correct, they can select ‘NO’, go back into the invoice screen and add to/amend the item number/s. The practice staff press ‘YES’ to accept the claim.
• A small receipt is printed from the EFTPOS device explaining what item numbers are being claimed and the patient is then asked the question “Do you assign your right to benefit?” This question appears on the EFTPOS terminal screen, and is also mirrored in the PMS, so that Practice staff can prompt the patient to select ‘YES’.
• Once the patient presses ‘YES’ on the EFTPOS device, the claim is submitted to Medicare Australia in real time.
• A second receipt is printed from the EFTPOS device for the patient, explaining that they have just assigned their right to benefit for xyz item numbers.
• In the PMS, practice staff are asked “Would you like to print a Practitioner copy?” (Medicare states that these copies do not need to be kept, so we would advise Practice staff not to print them).

See BIR or BBIR information in the Developer Portal.

For a rejected Bulk Billed claim:

• Unlike patient paid/part paid/unpaid claims, bulk billed claims are not fully assessed in real-time, they are only validated e.g. is the item number etc ‘valid’. This means that Practice staff will not get real-time rejections on bulk billed claims, they will need to continue to manage exceptions on the next day, as they do with Medicare Online claims currently.