Medicare Online

Claim using the internet
Medicare Online is a feature of most practice management software systems. It lets practice staff lodge Medicare claims through a secure internet connection. It can be used to process bulk bill, patient and Department of Veterans’ Affairs (DVA) claims and transfer immunisation data.

Medicare Online can be used by most health professionals, including allied health professionals and dentists.
Key benefits
The key benefits of using Medicare Online are:
· less paperwork
· faster payment
· greater patient satisfaction (when offering patient claiming)
· more certainty around pay doctor cheques
· automatic eligibility to the 90 day pay doctor cheque scheme for Medicare electronic claiming.
Features of Medicare Online
Medicare Online can be used for:
· bulk bill and/or patient claims
· DVA claims
· transferring immunisation data to the Australian Childhood Immunisation Register (ACIR)
· online patient verification
· electronic processing and payment reports
· lodging in-patient medical claims directly with Medicare Australia
· transmitting bulk bill claims 24 hours a day, seven days a week
· online Concession Entitlement Validation (CEV).
Did you know?
· Health professionals using Medicare electronic claiming no longer need to retain a copy of the Assignment of benefit form.
· Payments are made generally the next working day, for practices and patients, when receiving Electronic Funds Transfer (EFT) payments†.
· Medicare Online requires an internet connection, computer and practice management software.
· Medicare Online can be integrated with most practice management software.
† Excludes pathology that has a 14 day payment period and DVA claims that can be paid in as little as three working days.
How it works—bulk bill claims
Step 1
After the consultation, the practice management software creates a bulk bill voucher.
Step 2
You print off one bulk bill Assignment of benefit form for the patient to sign and keep.
Step 3
The practice management software submits the bulk bill claim to Medicare Australia for assessment and processing.
Step 4
Medicare Australia makes payment directly into your bank account within two to three days by EFT.
Step 5
Your bulk bill processing and payments reports are available within three working days.
How it works—patient claims (interactive)
Step 1
After the consultation, the patient pays as usual (cash, EFTPOS, credit card or cheque). You enter the service details into your practice management software as normal.
Step 2
You must ask the patient for verbal consent to lodge the claim electronically.
Step 3
If you are processing patient claims in real time, the practice management software submits the claim to Medicare Australia for instant assessment and processing. Notification is sent back through your practice management software immediately.
Step 4
Medicare Australia generally pays the Medicare benefit into the patient’s bank account the next working day. A cheque will be sent to the patient if they haven’t registered their bank account details.
Patients wanting to receive their Medicare benefit by EFT can register their bank account details with Medicare Australia so you don’t have to collect them. They can do this by calling 132 011*, visiting their local Medicare office or by filling in a Bank account details registration form available at their local Medicare office or at www.medicareaustralia.gov.au.
How it works—unpaid patient claims (store and forward)
You can use Medicare Online to request a pay doctor cheque if a patient takes an invoice instead of paying their account.
Complete steps 1 and 2 as above, then select the ‘pay doctor’ claim option in your practice management software. The patient will receive the cheque made out to the provider.
The patient takes the cheque to the practice and pays any balance remaining.
Note: cheques are not sent to practitioners directly due to legislative requirements.
Reconciling payments
Medicare Online is an integrated claiming channel, meaning your practice management software can ‘talk to’ Medicare Australia. Most practices using Medicare Online can therefore reconcile their bulk bill claims using electronic bulk bill processing and payment reports.
Same day delete
If necessary, you can delete a transmitted patient claim using your practice management software on the day you transmit the claim to Medicare Australia. This replaces the need to call Medicare Australia, and only applies to claims made in real-time, not those stored.
Claim documentation
If Medicare Australia accepts and assess a claim, a statement of benefit will be printed for the claimant’s records. If Medicare Australia does not fully assess the claim, a lodgement advice will be produced for the claimant.
Online patient verification
You can verify a patient’s eligibility for Medicare benefits online any time before or after a consultation. You simply need to enter their Medicare number, the individual reference number (the number to the left of their name on their Medicare card) and the patient’s first and last name. Within seconds, Medicare Australia will verify if the patient is known. In some cases, if certain details are incorrect, or if the Medicare card number is out of date, Medicare Australia will automatically return the correct details reducing the chance of rejected claims.
Note: as part of the claiming process for in-patient medical claims, online patient verification is done automatically.
Facts about Medicare Online
· Bulk bill claims are limited to 14 items per voucher.
· Processing and payment reports are available online for six months for each bulk bill claim processed.
Online security
Medicare Australia uses Public Key Infrastructure (PKI) to encrypt and secure all information electronically transmitted to and from Medicare Australia. PKI provides the highest levels of confidentiality, privacy and authentication available for transmitting medical data.
Getting started with Medicare Online
1. Contact your software vendor or IT support
Contact your software vendor to find out if they offer Medicare Online as part of their package. Your existing software may already have it built in.
For a list of software vendors offering Medicare Online visit www.medicareaustralia.gov.au then go to For health professionals > Doing business with Medicare Australia > Online business > Software vendor lists
2. Connect to the internet
You will need an internet connection, either broadband or dial-up, to use Medicare Online.
It is not necessary to have a broadband internet connection to use Medicare Online—normal dial-up services will work. However, if you wish to transmit real-time private patient claims or in patient medical claims, you need an internet connection that is always on. You can use a dedicated internet phone line that allows a dial-up connection to remain on all day instead of broadband. Alternatively, you can store your claims and forward them at a time that is convenient for you.
3. Register to use Medicare Online
Your practice must register before you can use Medicare Online. Once registered, you can transmit any type of online transaction from a location with online capability.
To download a registration form visit www.medicareaustralia.gov.au then go to For health professionals > Doing business with Medicare Australia > Online business > Register
When you have returned the completed form you will receive confirmation within two working days that your registration is successful.
Registration checklist
To connect your practice online with Medicare Australia, you need to make sure:
you have an internet connection
your software vendor has confirmed that your practice management software has Medicare Online built in
you have checked what security (signing) options your software offers
you have a digital site certificate
you have the personal identification code (PIC) for your site certificate. You must retain your original PIC in case of a system failure where you may need to re-enter this information
you know if you’re going to use a site and/or an individual/provider certificate.
your providers have registered individually for
business online
your practice has completed, signed and returned the Online claiming practice details form available at
www.medicareaustralia.gov.au then go to For health professionals > Doing business with Medicare Australia > Online business > Register
Medicare Australia’s business development officers can be contacted on 1800 700 199*.
You can find more information about Medicare electronic claiming in the following information sheets:
· Medicare electronic claiming choices
· Medicare Easyclaim
· Choosing practice management software for Medicare Online and ECLIPSE
· 90 day pay doctor cheque scheme for Medicare electronic claiming
· ECLIPSE
· Department of Veterans’ Affairs.