Reset and edit a Medicare claim

If a submitted Medicare claim is rejected or fails, you can reset the claim. This allows you to correct any errors in the claim, then resubmit it to Medicare through Halaxy. Resetting a claim typically happens automatically, but you may be required to manually reset or edit the claim.

Alternatively, you can also reset a claim by manually setting the claim status to Cancelled or Failed, which allows you to edit the claim details and resubmit.

Reset a Medicare claim for resubmission

  1. Open the invoice.

  2. Under Patient Rebates, click the claim status (blue hyperlink) to open the claim history.

    In the Patient Rebate section of an invoice, the Status of a line item is highlighted
  3. In the Online Claim History pop-up:

    Online Claim History pop-up, with lines for each claim. The Reset and Edit icons are highlighted.
    • Click the Icon-Undo.svg reset icon to automatically reset the claim for resubmission.

    • Click the Icon-Edit.svg edit icon to manually edit the status of the claim or change the amount provided by Medicare. Proceed to Step 4.

  4. In the Edit Medicare Item Details pop-up, change the amount paid and reason status as required:

    The Edit Medicare Item Details pop-up. In the Reason drop-down menu, "Rejected/failed" is selected.
    • If you are editing the status of a claim that has already been paid:

      • Amount Paid from Funding: Enter the total amount paid for this specific claimable item, including funding paid in a previous Medicare claim attempt for this item. Do not include any other claimable items.

      • Amount Paid from Medicare/Patient Rebate: Enter the amount paid from this specific Medicare transaction only. Do not include funding paid from previous Medicare transactions for this item. (Note: This is usually the same as the Amount Paid from Funding, but may be different if funding has previously been paid or if multiple claimable items are included in the transaction.)

      • Reason: Select Paid.

    • If you are resetting a rejected or failed claim for resubmission:

      • Amount Paid from Funding: Enter the total amount paid for this specific claimable item - typically $0.00 for a failed claim.

      • Amount Paid from Medicare/Patient Rebate: Enter the amount paid for this specific Medicare transaction only - typically $0.00 for a failed claim.

      • Reason: Select Rejected/Failed.

  5. Click Save.

The invoice updates to show the new amount and status.

If the claim was set to a Cancelled or Failed status, it can now be reprocessed.

Tip

You can "unreset" a claim by following the above process and clicking the Revert icon.

Updated

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