Bluechip User Guide
Medicare Window

The Medicare window allows you to process claims using Medicare Online  and track the progress of Inpatient Medical Claiming via ECLIPSE.

Claims can be sorted by clicking on the column heading. This allows claims to be grouped and processed together for reporting and transmission to Medicare. An arrow in the column header denotes the currently "sorted by column" and the direction of the sort.

 

From this window you can:

o      Filter the list of claims by using the controls in the Claim Selection section at the top of the window.

Once you have made a change to the criteria in this section, click to apply the change, filtering the list accordingly. Note that you can also tick the Quick Refresh check box which automatically refreshes the window with each change you make to the Claim selection criteria in the window.

 

o      You can quickly locate a specific claim if you know its Claim ID, by typing the ID into the Find Claim text box and clicking the associated button.

o      Manually transmit claims that are awaiting transmission. By default, claims are sent immediately upon invoicing them. However, if for example your Internet access is not available at the time, claims are held in a pool, awaiting manual transmission later. All claims whether transmitted or awaiting transmission, can be found in the Medicare Australia - Online Claims Window.

o      View a claim's transmission log.

 

o      Open a selected claim to view the results of processing, and to finalise receipting or rejections, as shown below.

 

Items of interest on the Medicare Australia Online Claims window

From Date

Allows you to select a From date for the claims listing.

The 'from date' is displayed automatically as 14 days prior to the current date or the earliest date of a claim in the claims list that has not been finalised.

To Date

Allows you to enter a To date for the claims listing.
The 'to date' is displayed as the current date by default.

Claim Type

Filters the list of claims to show only claims of type;

  • All

  • Bulk Bill

  • DVA

  •  Easyclaim

  • Eclipse

  • Patient Claim

Claim Status

Filters the list of claims to show only claims where the status is;

  • All

  • Awaiting Submission

  • Awaiting Process Report

  • Awaiting Payment Report

  • Ready to Finalise

  • Finalised

Exclude Finalised Claims

Allows you to exclude receipted claims by selecting the check box.

 

Selects/Deselects all payees within the Payee Rooms list (see below).

Payee Rooms

Displays a list of the payees and the room location to which funds will be paid.

Quick Refresh check box

Automatically refreshes the window with each change you make to the window.

Allows you to refresh the window. When a change has been made to the window the Refresh button is displayed in bold. This indicates to the user that this button should be clicked to reflect the current selection options in the claims section of the window.

Locate a specific claim from within the list displayed by entering the Claim ID, and clicking the Find Claim button.

Date

Displays the date the claim is created in Bluechip.

Claim ID

Displays the claim ID. The Claim ID is the unique Claim ID generated by Bluechip.

The Claim ID follows the format xnnnn@ where:

  • x is and alpha character (except I or O) or # for in-hospital services (note: the # is not used for DVA claims unless one of the vouchers in the claim has an 'Hospital' referral type. If this is not the case, the letter A is used).

  • nnnn is a four(4) digit number. Should this number exceed 9999, it will be reset to 0.

  • @ identifies the claim as an electronic claim for Medicare Online.

  • * identifies store and forward claims.

Room

Displays the Practitioner name and room location.

Vouchers

Displays the number of vouchers in a claim. Should items in a claim be rejected, the number of rejected items is shown in brackets after the number of vouchers.

Total

Displays the total amount of a claim.

Status

Displays the status of the claim. The statuses are:

  • All Rejected

  • Awaiting Authorisation

  • Awaiting Payment Report

  • Awaiting Process Report

  • Awaiting Submission

  • Finalised (All rejected)

  • Finalised (Deleted)

  • Finalised (Manually Receipted)

  • Finalised (Receipted)

  • Ready to Finalise(R)

  • Same Day Delete*

  • Ready to Receipt

* Available if the deletion is done within 24 hours of claim submission.

 

Note that these are displayed here in alphabetical order, and not in the order in which they might occur in practice.

For more information about the Status field, and how the status changes during a claim, see Medicare Claim Status.

Allows you to create a new claim.

Allows you to view the details (such as invoices and Service Items) that have been transmitted to Medicare.
Note: This option is only available when a single claim has been selected.

Allows you to delete an existing claim provided it has not been transmitted to Medicare or it is being deleted on the same day as the transmission.
Note: This option is only available when a single claim has been selected.

Allows you to transmit the claim. All selected claims will be processed, with the next step in the claims process being executed for the respective claim. Processing will continue until a step in the processing sequence fails. At this point the next claim will be processed (when multiple claims are selected).

Items that have been rejected by Medicare can be processed with this button. This is only available when a single claim is selected and rejected items exist for the selected claim.

Allows you to receipt items that have been paid by Medicare. This process if only available when a single claim is selected and paid items exist for the selected claim.

When viewing Patient Claims: This function will update the status of a Patient Claim to "Finalised (Receipted)". Once a practice has received monies owing from Medicare, the status of the claim can be updated so as to remove it from the displayed list. This function does not produce a receipt; it will only update the claim status.

Allows you to view the transaction log.

Allows you to update patient details according to information received from Medicare.

Notes on Reports for Medicare Online

o      All Medicare Online reports are access through the print report interface, and will be represented in a Medicare Online category. The claims window must be active to see this report category. The claims represented in the reports are those claims currently selected in the claims list.

o      Some reports are for a single claim selection only.

Notes on the Claims Window

o      Only claims meeting the claim selection criteria will be displayed;

o      All Payee rooms will be listed in the "Payee Rooms" list. Payee rooms which have are flagged as deleted / inactive will annotated as such.

o      Claims which are of a "Store and Forward" type will have an asterisk (*) at the end of the Claim ID.

o      Claims which have been "Same Day Deleted" will be shown in red with a line through them.

o      New Patient Claims cannot be created from the Claim List window.

o      The "New" function will be disabled then the Claim Type is set to "Patient Claims".

o      All Patient Claims must be created from the Accounts window.

o      The "Open…" function will only be enabled when a single claim is selected.

o      The "Delete…" function will only be enabled when a single claim is selected.

o      The "Delete…" function will remove the Patient Claim from the Bluechip database if it has not yet been submitted.

o      If a patient claim has been submitted the "Delete…" function will initiate a "Same Day Delete" process.

o      The transmit function is available for single or multiple claims. Only claims with a status requiring transmission will be processed.

o      The "Receipt…' function is not applicable to Patient Claims with a status of:

       Finalised (Receipted)

       Same Day Delete

o      The "Log…" function will only be enabled when a single claim is selected.