Medicare Bulk Bill Payment Run Logic

• BBe has an Early payment cut off of 17:30 on each RBA operational day (the normal cycle is Monday to Friday).
• BBe Claims which miss this cut off will be picked up for payment in the next scheduled Early payment run.
• For example; a BBe claim is successfully assessed at 17:40 on a Friday, will be included in the following Monday 17:30 BBe Early payment run.

What is the logic of a payment run, is it even based on time periods or something else?

• A BBe early payment run occurs on every RBA operational day @ 17:35, sending the payments to the RBA before 20:00.
• This will pay BBe claims which have been successfully assessed and the associated provider has active Medicare registered bank details.
• A BBe claims’ date of lodgement does not affect when or what payment run will pay the claim.
• BBe claims associated with providers who do not have active Medicare registered bank details, will be withheld from being paid until bank details are supplied.
• Once the provider has active Medicare registered bank details, the withheld claims are released and paid by the standard Medicare payment run.
• The standard Medicare payment run occurs on every RBA operational day after midnight, sending the payments to the RBA @ approx. 8:30am

Does Medicare pay Easyclaim and Online payments in a lump sum or not?

EFT payments to a payee providers account are based upon the payment run making the payment and the claim type;

• The BBe early payment run will make one EFT payment for all the BBe claims which have made the cut off.
• The Standard Medicare payment run can make several separate payments, based upon the claim types;
  • One payment for all/any released BBe claims which were previously withheld due to missing bank account details
  • Another separate payment for all/any Online (DBS) claims
  • A final third payment for all/any Manually lodged claims

As such it could be possible for a provider to receive on a single day multiple payments into their account, one for each of the above categories. The separate payment groupings have been done to assist with PMS system reconciliation functions.

In what cases would claims from one provider, during one business day, be split into two separate payment runs?

This situation is often a result of the following scenarios;

1. The BBe claim lodged with DHS has missed the days early cut off and is picked up in the following days early payment run (this could be over the weekend).
2. The BBe claim lodged with DHS requires additional manual assessment intervention and as such may not reach ‘successful assessment’ until after the date of lodgement.