Processing Medicare and DVA rebates

Watch the online claiming video

After you are registered for online Medicare rebates claiming, you can process Medicare and DVA rebates quickly and easily using HealthKit. Rebates can be provided direct to patients (for patient Medicare rebates) or to practitioners (for bulk-bill and DVA rebates) overnight without the hassle of going to a Medicare office, and without the expense of investing in an eftpos facility (which in any case is more time-consuming to use than online claiming). This section describes in detail how to process Medicare, bulk-bill and DVA rebates, and you can watch this short training video to see it in action.

If you have any queries about a specific invoice, you can contact Medicare on 1800 700 199.

Contents

Patient Medicare rebates

Processing patient Medicare rebates
Adding patient deposit account details

A Patient Medicare rebate is where the patient pays the whole invoice and the rebate is paid to them: for example, your appointment fee is $110 and the rebate is $80; the patient pays you the whole $110 and then claims back $80.

If the appointment and invoice are eligible for Medicare rebates:

  1. Accept payment through electronic payments processing or by clicking Mark as Paid; you must do this before you process the rebate as if you do not, Medicare will send the rebate as a cheque in your name to the patient's address which is usually inconvenient for practitioners and patients.
  2. Click the Process Rebate button located at the bottom of the invoice (for a Bulk Bill invoice click the Process Bulk Bill button just above it). You can select and deselect fees on the invoice if the invoice has multiple fees that can be processed, and where required, you can confirm whether the treatment was aftercare-related or not (see below). You can also leave the rebate to be processed later in a batch.

If the claim meets Medicare’s criteria, you receive a message that the claim was successfully submitted to Medicare, with the Statement of Claim and Benefit shown, that you can (but are not required to) provide to the patient. If Medicare accepts but cannot immediately process the claim, you are provided with the Lodgement Advice (that you may provide to the patient) and the claim goes through an extra level of checking by a Medicare officer with the rebate generally processed up to three days later.

If the claim is not successful, Medicare advises you of the error code so that you can rectify the issue.

The rebate amount is provided to the patient (or claimant if you have added a claimant to whom the rebate is paid) in one of three ways:

  1. Into their bank account, using the bank deposit account details that you have entered on the Funding page of their profile;
  2. Into their bank account, using the bank deposit account details that the patient has provided Medicare directly (although only a small proportion of patients have done this so adding patient bank account details is preferable); or
  3. If no bank details are available, in a cheque sent to the patient at their address listed with Medicare.

Adding patient deposit account details

Adding patient bank account details ensures Medicare can provide rebates to them overnight. Only savings and transaction accounts can be added because Medicare will not pay rebates into credit cards (though debit accounts are acceptable). To add patient bank deposit account details, go to the Funding page on their profile, and click the Add Account button. Enter the patient's account name and deposit account information (branch code and account number) and click the Save button. The account details are saved to the patient's profile. Whenever you successfully submit a rebate claim to Medicare on behalf of the patient, the rebate will be deposited into this account.

If a claimant is listed, the rebate is paid into the claimant's account and not the patient's.

Bulk bill and DVA rebates

Processing bulk bill claims

A bulk bill rebate is where the appointment is bulk billed: for example, the rebate available is $80 and your fee is $80, which you claim through bulk billing from Medicare (i.e. you are paid the rebate directly), and the patient pays nothing. A DVA rebate functions almost in the same way as a bulk bill rebate, except that the rebate is provided by DVA (the Department of Veterans' Affairs) rather than Medicare, and it is Medicare who administers the process on behalf of DVA. The information in this section applies to bulk bill and DVA rebates.

If the appointment and invoice are eligible for Medicare or DVA rebates and you want to process it as a bulk bill or DVA claim:

  1. Click the Process Bulk Bill / Process DVA button to see the Declaration by Practitioner or Optometrist who Rendered Professional Services (optometrists can also select whether an Optical Script was written or not); then
  2. Click the Process button to confirm the claim and send it to Medicare/DVA (you can also leave the rebate to be processed later in a batch). Where required, you can:
    • Select and deselect fees on the invoice if the invoice has multiple fees that can be processed;
    • Add additional information to the claim if the claim would otherwise be ineligible (click here for more information); the claim is processed manually by a Medicare representative rather than automatically, which may delay payment by 1-2 days (and so additional information should only be added where absolutely required) - you can see this in action in this mini-video; and
    • for patients who have recently been in hospital based on Medicare's records, confirm in the dropdown menu whether the treatment was aftercare-related or not (if the treatment is not aftercare-related, Medicare pays the claim; if the treatment is aftercare-related, Medicare does not pay the claim). This is not relevant for DVA claims.

If the claim is successfully submitted, you receive the Bulk Bill Assignment Advice / DVA Health Practitioner Services Voucher which you can (but are not required to) print and give to the patient. The invoice status changes from Not Yet Paid to Pending between when you process the rebate and the rebate being paid into your bank account. The day after you process a rebate, you can confirm that the rebate has been processed on the invoice or by running a Medicare Claims report. If a rebate status remains pending after more than 3 days, you may not have registered this practice location with Medicare for online claiming purposes (you must complete the Online Claiming Provider Agreement for each provider number you have). You can call Medicare on 1800 700 199 to confirm whether the location is registered for online claiming purposes; if it is not, complete the registration form and send it to Medicare. After the location is registered, you can then reset and resubmit the rebate.

If the claim is not successful, Medicare/DVA advises you of the error code so that you can rectify the issue.

Special rules and things to note for DVA claiming

Medicare has a small number of special rules that relate only to DVA rebate claiming:

  1. Travel claims to DVA can only be submitted on an invoice with an appointment fee; travel claims cannot be submitted on an invoice by themselves. Because DVA does not pay for the first 10km travelled (or 50km in the case of item number OT80), HealthKit automatically calculates the amount you are claiming for you minus the first 10km (or 50km for OT80). e.g. If you are have driven 30km to see a patient and enter 30 into the Quantity field at a rate of $0.90 per km, HealthKit automatically calculates claim as $18.00 (i.e. 20 x $0.90) not $27.00. This automatic calculation ensures that invoices balance after DVA has paid the claim.
  2. If the fee's item code is eligible for out of room loading paid to the practitioner, you do not have to do anything additional to the invoice and fee as DVA automatically works it out for you.
  3. If the patient has a white DVA card and you are an allied health practitioner, you may need to specify the accepted disability in the Accepted Disability field, which you can do when you add or edit the patient's DVA claim details. You can see this in action in this mini-video.

Confirming that a specific Bulk bill / DVA rebate claim has been paid

Medicare and DVA daily report

There are two ways you can confirm that a Bulk bill or DVA rebate claim has been paid: (a) by running a daily report; and (b) by checking on an individual invoice.

You can confirm that Medicare/DVA has paid the claims for a particular day on your Reports page (under the Finance tab) and clicking the Medicare tab. A report is automatically created for you on the day after you process bulk bill or DVA rebate claims, showing the amount that Medicare/DVA transferred to you overnight, with a separate report for each provider number. Click the date to see the full Bulk Bill and Payments Processing Report, which specifies which rebates were paid and which were not, and how much was paid for each rebate.

Processing bulk bill claims
Bulk Bill Processing and Payments Report

On the day after you processed a specific bulk bill or DVA claim, you can also confirm that Medicare/DVA has paid the specific claim by going to the specific invoice. For example, if you processed the claim on Monday, on Tuesday you can confirm that the claim was paid.

To confirm that the bulk bill/DVA claim was processed, click the Get Report button near the bottom of the invoice, which takes you to the Processing and Payments Report, which shows you (a) how much you were paid, (b) for what service, and (c) when. For each fee processed, the report shows when you were paid the same amount as you claimed, when you are paid more than you claimed, and when you paid less than you claimed. When you access the report and there is a difference between the amount you claimed and the amount you received, the invoice is updated with the actual amount you received, and Medicare provides you with a reason code, which is also called an explanation code. Common codes are listed below.

Common Bulk Bill and DVA reason/explanation codes
Code Description and action
160 The patient has reached the maximum number of appointments covered under the referral. Contact Medicare on 1800 700 199.
162 You have already claimed for this service, so you cannot claim again.
217 The patient information is incorrect or missing. Edit or update the patient's name or address in the Patient section of the invoice (which updates their patient profile). Edit or update the Medicare card or reference number in the Medicare claim section of the invoice (which updates the patient's Funding page).
255 The amount payable for this service has increased from the amount you claimed. You have been paid at the higher level, but you should update your fees by editing them on your Fee List.
374 An expired Medicare card has been used - obtain the patient's updated Medicare details and add them on the Medicare claim section of the invoice (which updates the patient's Funding page).
540, 550 Enhanced primary care plan item not previously claimed. The referring GP likely has not yet submitted the referral information to Medicare, or has submitted incorrect referral information to Medicare. Wait two days and process again. If the claim still cannot be processed, contact Medicare on 1800 700 199.
600 Requesting/referring provider unable to be identified. The referring GP's provider number is likely incorrect. Check it on the referral you received and edit the referral details on HealthKit so that the correct provider number is shown.

If the amount you receive is less than you claimed, you can:

  1. Re-submit the invoice with a different item number if the reason for the difference is that the wrong item number was used; or
  2. Edit the fee amount so that it is the same as what was paid - this is preferable to doing nothing as this way your invoice is balanced.

If the report shows that the claim was not paid, rectify any problems with the invoice based on the error codes provided. Medicare then allows you only one attempt to re-process the claim. If a rebate status remains "submitted" three business days after you tried to process it, you should contact Medicare on 1800 700 199 and confirm that Medicare has registered your Minor ID (see Users page), provider number for this location (see Identifications) and bank account. The Online Claiming Provider Agreement needs to be completed for each provider number you hold; if you have not, Medicare does not pay the rebate to you and the status remains submitted. After your Minor ID, provider number for this location and bank account have been registered by Medicare, reset and then resubmit the rebate.

Bulk bill and DVA reports also include card flags, which indicate that although a rebate has been processed, there is a problem with a Medicare/DVA card that you submitted. For example, flag W lets you know that the patient card used will soon expire. It does not prevent rebate processing.

The claim payment information at the bottom of the Report that Medicare/DVA provides is in fact the daily claim amount paid to you, and not just the claim amount paid to you for this particular invoice.

Batch processing

Medicare and DVA batch processing

As well as processing each Medicare or DVA rebate individually, you can process all rebates for a particular time period in a batch at the one time, saving you time and effort. You can process patient, bulk bill and DVA rebates through batch processing. The rebate is received in the same way and at the same time as you otherwise would receive the rebate.

To batch process your rebates, go to the Reports page under the Finances tab and click the New Report button at the top right. Select Unprocessed Medicare claims from the report type and choose from the relevant filters (Do not change the filters if you want to see all unprocessed Medicare rebates):

  • Appointment age: the days since the the earliest date of the first rebate to be processed (e.g. if you select 5 days, all eligible unprocessed rebates are shown on the report).
  • Practitioner: select the practitioner about whom the report is being run. You can run the report for your whole practice by selecting All Practitioners. If you are a sole practitioner the report is run solely for you.
  • Location: select the practice for which you are running the report. If you have only one practice location, the report is run solely for that practice.
  • Type: select from patient rebates, bulk bill or DVA rebates, or select All if you want to process all rebate types.

When you click the Run button, your unprocessed Medicare rebates that meet your criteria are shown. You can either:

  • Select individual rebates to process by clicking the relevant Process Rebate link next to the rebate; or
  • Click the Select all box then click the Process All link at the top right of the report.

After you confirm that you want to process the rebate/s, the rebates are processed in the background. A green notification button appears on your screen next to your login area when the rebates have been processed; you can click the notification button to see which rebates have been successfully processed and which rebates have failed (so that you can rectify the problem and process them again).

If an invoice balance is shown in red, Medicare will send the patient the rebate as a cheque in your name. This is not desirable - to prevent this from happening, make sure the invoice is marked Paid before you process the rebate.

Automated Medicare and DVA processing

Setting up automated Medicare & DVA rebates

In addition to processing each Medicare and DVA rebate and bulk bill individually or through batch processing at the end of the day, you can automate your processing at a specific time into the appointment, for example 20 minutes after the appointment has begun. Alternatively you can set the processing to occur up to two hours to give you buffer time if your appointments are running over. You can also choose to process your rebates and bulk bills automatically at a specific time of the day.

To set up automated processing, go to the Payments page under Profile tab and click the Edit icon next to Scheduled Rebate Processing. To change the settings so that they are set at the clinic level or individually, instead of the group default, click the Add New button. For clinic level, select Clinic and choose the required clinic(s). For individual practitioners, select Individual. You can then choose All clinics or Selected clinics and which practitioners these settings apply to.

To process the rebates and bulk bills automatically, select:

  • “mins into the appointment” and the number of minutes or
  • “each day and choose the time the rebates are to be processed.

Then select Save.

When will the rebate not be processed

Rebates are only processed for patients with an appointment status of ‘’Attended’’. This means if your patient does not attend their appointment, the rebate or bulk bill will not be automatically processed. It also means no HealthKit credit is charged for the processing.

Claiming reports - seeing a list of Medicare and DVA claims processed

Checking for rebates with a status of Submitted

There are three types of reports that you can use to see a list of rebates processed, described below.

Medicare-generated reports (Bulk Bill and DVA)

You can see a complete list of bulk bill and DVA rebate claims on the Medicare-generated report which is shown the day after you process a Medicare or bulk bill report.

This report enables you to reconcile the amounts Medicare/DVA pays you as the Medicare-generated report shows the payment date, total amount paid and the reference number, which also appears in your bank account.

This report does not show rejected rebates.

Medicare claims report (Bulk Bill, DVA and patient-paid)

The Medicare claims report shows a full list of all patient-paid, bulk bill and DVA rebates, including rebates successfully processed, rebates unsuccessfully processed and rebates whose status is submitted.

To create a Medicare claims report, Go to your Reports page under your Finances tab, click the New Report button at the top right of the page. Select Medicare Claims in the Report Type drop down menu, and select the date range and other parameters (e.g. for a particular practitioner or location, or for rebates with a status of Submitted), then click the Run button. A list of your rebates is shown including patient, bulk bill and DVA rebates as well as their status (successful, unsuccessful, submitted) -

  • If a rebate is shown as unsuccessful, look at the error code or explanation code shown on the report and made the changes required, then resubmit the rebate.
  • If a rebate is shown as submitted, contact Medicare to confirm that your Minor ID, provider number for this location and bank account have been correctly registered by Medicare and then reset and then resubmit the rebate.

If you contact Medicare about a rebate and they ask you for the claim ID, you can find the claim ID on the Medicare Claims report. Claim IDs are in the format Letter-digit-digit-digit-digit-@ - for example, L8765@.

This report provides a full list of rebates processed, but it can be time consuming to find only rebates with only one specific status, such as unpaid bulk bill and DVA rebates.

Unpaid invoices report (Bulk Bill and DVA)

The Unpaid Invoices report shows all invoices that are not yet paid, including bulk bill and DVA rebates.

On your Reports page under your Finances tab, click the New Report button at the top right of the page. Select Unpaid Invoices in the Report Type drop down menu, and select the date range and other parameters (e.g. for a particular practitioner or location, or for rebates with a status of Submitted), then click the Run button. A list of your unpaid invoices is shown -

  • If a rebate is shown as unsuccessful, look at the error code or explanation code shown on the report and make the changes required, then resubmit the rebate.
  • If a rebate is shown as submitted, contact Medicare to confirm that your Minor ID, provider number for this location and bank account have been correctly registered by Medicare and then reset and then resubmit the rebate.

If you contact Medicare about a rebate and they ask you for the claim ID, you can find the claim ID on the Medicare Claims report. Claim IDs are in the format Letter-digit-digit-digit-digit-@ - for example, L8765@.

What to do if a rebate claim is unsuccessful

If you receive a message that the rebate claim was unsuccessful, you will receive a message stating the error code as well as a link to a report from Medicare which may describe the error. You can either click the Accept button to continue submitting the claim to Medicare, for a case officer to review (you will be provided a Lodgement Advice), or click the Reject button to stop the claim being processed, so that you can rectify any errors and then submit the claim again. First try to resolve the issue yourself by following any instructions the error code provides (e.g. by adding the patient's deposit account name for error 9323). If that is unsuccessful, in all cases you should contact the Medicare eBusiness Service Centre on 1800 700 199. Common error codes are listed below.

Common error codes
Code Medicare description Further information and action
3001, 3004 Communication error; check that you have a current internet session There is a problem with connection either from Medicare, HealthKit or your end; check your own internet connection and you are connected to the internet, wait a few minutes and try again.
7078 Medicare Item Num Relevant for DVA claims. Specify the number of kilometres for travel claiming purposes in the invoice (edit the invoice if needed).
9119-9125 The provider is identified as inactive for Online Claiming purposes You usually receive this error when Medicare has not yet processed your Medicare online claiming registration. It usually takes 5 business days for Medicare to register practitioners, so wait until this time has elapsed before trying again (see here for more information on registering for Medicare).

If you are an allied health practitioner and the first claim you ever process is a DVA claim, you receive error 9125 (it is a bug in DVA's claiming system, that does not happen when the first claim you process is a Medicare claim). The way to overcome it is to run an Online Veteran Verification first (which allows you to check whether the DVA card details you have are correct or not), then process the claim. All future claims will be processed normally.

9201 Invalid format for data item Something required for processing purposes has been left blank - e.g. the patient's Medicare number or date of birth, the referral date or the referring GP's provider number is missing. Check and edit the invoice and process the rebate again.
9205 Data item empty The claim requires a Medicare officer to review it. Call Medicare on 1800 700 199 to discuss it.
9301-9304 Patient's Medicare card number (9301), reference number (9302), first name (9303) or surname (9304) must be supplied The required patient information is missing. You can add the patient's first name or surname in the Patient section of the invoice (which updates their patient profile), or the Medicare card or reference number in the Medicare claim section of the invoice (which updates the patient's Funding page).
9305, 9308 Servicing Practitioner's Provider Number (9305) or Referring Practitioner's Provider Number (9308) must be supplied Your Provider Number or the referring GP's Provider Number is missing or incorrect. Edit your Provider Number on your Identifications page, and/or edit the referring GP's Provider Number by clicking the Edit icon in the Medicare claim section of the invoice, and process the claim again.
9309 Referral issue date must be supplied The date of the referral is missing or after the date of your appointment with the patient. Edit the referral date in the Medicare claim section of the invoice (which updates the referral information on the patient's Funding page), and process the claim again.
9313, 9314, 9315 Patient/Claimant address line (9313), locality (9314) or postcode (9315) must be supplied or all claimant address elements removed One or more of the patient's address details that you have entered on HealthKit are spelt wrongly or is incorrect. Go to the Patient section of the invoice and check and update the patient's address, particularly spelling of street name and suburb (e.g. Lake MacDonald might be incorrectly spelt as Lake McDonald). Updated information is also saved on the patient profile.
9323 Incomplete banking details - BSB code, account number and account name must all be supplied The patient's bank details are incorrect or are missing some requirement elements. Confirm the bank details with the patient (or claimant), and update the patient's bank details on their Funding page.
9630 Please check the request or referral details The referral is either incorrect or has run out, due either to the number of appointments or referral length having run out. Check the referral information on the patient's Funding page.
9638, 9312 Claimant details required - patient or quoted claimant is a minor, or claimant details are missing (9312) The rebate cannot be provided to the patient because the patient is under the age of 18. Add a claimant (e.g. a parent) or edit details of a claimant to whom the rebate is paid by adding their Medicare and deposit account details on the Medicare Claim section of the invoice.

Resubmitting and cancelling rebates

How to resubmit claims

You can resubmit invoices that have not yet been paid as many days after you first submitted the claim as you need. You can also cancel patient rebates through HealthKit on the same day that you processed them. You can cancel bulk bill and DVA rebates on the same day that you processed them, but only by calling Medicare on 1800 700 199. You cannot cancel rebates after the day that you processed them through HealthKit - you must contact Medicare on 1800 700 199 to discuss the situation with them.

Resetting and resubmitting rebates

To resubmit an invoice, you first need to reset the invoice, which you can do by going to the Invoice and clicking the Get Report button. Because you have not successfully submitted the claim, there will be no report available, and the message from Medicare tells you how many days ago you tried to process the claim. Click the Reset button and confirm that you want to reset the invoice. You can then re-submit the invoice straight away.

You can "unreset" an invoice that has already been reset by following this process and clicking the revert icon.

Cancelling patient rebates on the same day

Under Medicare's rules, you can cancel a patient Medicare rebate on the same day as you submitted the claim before 9:00pm, but not after that time (to cancel a bulk bill rebate you must call Medicare).

To cancel a patient rebate on the same day, click the Cancel Rebate button at the bottom of the invoice, then select the reason for cancellation (e.g. incorrect item number or patient details) in the pop-up box. Click the Yes button that you are sure you would to cancel the rebate, and the rebate processing is cancelled.

Cancelling bulk bill and DVA rebates on the same day

You can only cancel a bulk bill or a DVA rebate on the same day as you processed it, and Medicare does not allow you to cancel the rebate electronically. To cancel a bulk bill or DVA rebate on the same day, call Medicare on 1800 700 199. You are able to reset the bulk bill or DVA claim.

You can see this in action in this mini-video.

Cancelling rebates after the same day

Because Medicare processes rebates on the same day that you process the claim (with rebates going to you or your patient overnight), you cannot cancel rebates that have been processed after the day that you processed the claim.

Voiding Medicare rebates

If you have processed a Medicare or DVA rebate but need to change the fee to another funding body (i.e. not Medicare or DVA), you can void the Medicare fee which keeps a record of the Medicare/DVA fee for audit purposes but removes it from the physical copy of the invoice. Click the Cancel icon (which looks like a cross) next to the Medicare fee and then select Void; you can add the new fee by clicking the Add Another Fee button. You can access the previous Medicare or DVA fee by clicking the Settings icon at the top right of the screen, which is also where you can "unvoid" the Medicare/DVA fee.

You can see this in action here in this mini-video.

Purchasing HealthKit credits

Claims processed through Medicare and DVA are 1 HealthKit credit. One credit is $0.22AUD. You can also buy HealthKit credits in bulk and save.

To purchase HealthKit credits, go to the Payments page under your Profile tab and click the Purchase Credits icon. Enter the value of HealthKit credits that you would like to purchase, and HealthKit tells you the number of credits that can be purchased for that credit amount (for example, $30 gets you 137 credits). Complete your payment details, and click the Add button to confirm purchase.

From 22nd October, HealthKit credits are charged on Medicare and DVA rebates and bulk billing processing.

Topping up your HealthKit credits

Automatic top up of HealthKit credits

You can set HealthKit credits to automatically top up when there are 10 credits left, thus ensuring that you always have enough credits for claims to be processed without you needing to check how many credits you have left.

Auto top up is initially disabled, and you can enable it by clicking the Modify button. In the Amount field, enter the amount that you wish to be automatically added when you have 10 credits left. Click the Enable button to enable Auto top up.

Watch this mini video for more information on HealthKit credits.


Videos

I need to add additional information to my Medicare claim - how do I do it? How do I process two Medicare rebates for the same patient on the one day?

After you have clicked the Process rebate button on the invoice, enter the information in the Additional Information field, which is submitted to Medicare when you click the Process button.

How do I add the accepted disability on a DVA claim?

You can add the accepted disability when you add the patient's DVA card details - you can do this either on the patient's Funding page, on the invoice or on the appointment.

How do I cancel and reset a Medicare rebate paid to a patient?

Click the Submitted link on the invoice and then the Cancel icon and then the Reset button; the rebate is now reset to not yet processed and the rebate cancelled. You can only do this on the same day that you processed the claim; otherwise, call Medicare on 1800 700 199.


How do I reset a bulk bill or DVA rebate (i.e. a rebate to be paid to me/my practice)?

Click the Get Report button on the invoice and then the Reset button and confirm; the rebate is now reset to not processed and the rebate is cancelled. You can only do this on the same day that you processed the claim; otherwise, call Medicare on 1800 700 199.

Why is my bulk bill still showing as pending after several days?

This may be because your details were not registered with Medicare when you submitted the claim, specifically your Provider Number and Location ID Number. Call Medicare on 1800 700 199 to confirm the details then click the Get Report button on the invoice and then the Reset button and confirm; the bulk bill is now reset to not processed. You can now reprocess the bulk bill.

I processed an invoice as a Medicare/DVA invoice, but need to change it to another funding arrangement. How do I do this and how do I void the Medicare/DVA fee?

Click the Cancel icon (which looks like a cross) next to the Medicare fee and then select Void. The fee is not shown on the invoice but the fee history is kept for audit purposes (which you can access by clicking the Settings icon at the top right of your screen). You can then add the new fee.