The integration of Medicare and Halaxy allows your practice to quickly and seamlessly process claims within the Halaxy platform. This article explains how a Medicare claim goes from Halaxy to Medicare and what information you need to provide to successfully process a claim.
When you submit a patient-paid Medicare rebate claim to Medicare, the following happens in sequence.
Image: How a Medicare patient rebate is processed after you submit the claim
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Halaxy checks the information in the submitted claim.
Validation
Events
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Patient date of birth
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Medicare card number
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The servicing practitioner's provider number
Validation passes: The claim is submitted to Medicare. Process continues to the next step.
Validation fails: You receive an error in Halaxy, advising you of the missing information.
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Medicare checks the information in the submitted claim.
Validation
Events
Additional info
When Medicare completes its validation, the outcome is updated in the invoice's rebate status. Process continues to the next step.
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Lodgement Advice: After you submit the claim, Medicare provides a Lodgement Advice, which contains the Claim Reference ID. You can access this by clicking View Statement on the invoice.
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Claim status report: The day after you submit the claim, Halaxy requests reports from Medicare regarding the claim status, which you can retrieve by clicking Get Report on the invoice. (Halaxy has no control over when reports are received.)
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Additional time required: If you entered details in the Additional Information field when submitting the claim, a Medicare officer will need to review the claim.
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After Medicare's validation, there are three possible outcomes.
Outcome
Events
Additional info
SuccessInvoice claim status: Successful / Completed
The claim is successful and Medicare pays the rebate into the patient's or claimant's registered bank account.
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Statement of Claim and Benefit Payment: Medicare provides this, which states the Claim Amount and the Claim Reference ID. You can access this by clicking View Statement on the invoice.
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Rebate amount: Medicare pays the rebate amount based on its own schedule, regardless of what you set as the rebate amount on the invoice.
FailureInvoice claim status: Rejected / Schedule Failed
The claim failed Medicare's validation process, or the benefit is not payable for another reason.
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Error code: Medicare provides an error on the report, which you can access by clicking Get Report or View Report on the invoice. Use the report to identify and fix problems in the claim, then resubmit the claim. See article: Troubleshoot Medicare error codes
UncertainInvoice claim status: Lodged / Incomplete / Cancelled
Medicare is unsure and will need to review the claim further.
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Options: Click the claim status on the invoice to either cancel the claim or push the claim through for further processing. Based on Medicare's advice, you may need to contact them or manually reset/resubmit the claim.
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No notice: Halaxy is not informed about the status of the claim or of any updates in further reviews.
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Reporting visibility: Uncertain claims are considered lodged, so they do not appear on the Unprocessed Rebates financial report.
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When you submit a bulk bill or DVA claim to Medicare, the following happens in sequence.
Image: How a bulk bill or DVA rebate is processed after you submit the claim
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Halaxy checks the information in the submitted claim.
Validation
Events
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Patient date of birth
-
Medicare or DVA card number
-
The servicing practitioner's provider number
Validation passes: The claim is submitted to Medicare. Process continues to the next step.
Validation fails: You receive an error in Halaxy, advising you of the missing information.
-
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Medicare checks the information in the submitted claim.
Validation
Events
Additional info
When Medicare completes its validation, the outcome is updated in the invoice's rebate status. Process continues to the next step.
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Patient documents: Medicare supplies the Assignment of Benefits statement or the DVA Service Treatment Voucher, which can be provided to the patient.
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Lodgement Advice: After you submit the claim, Medicare provides a Lodgement Advice, which contains the Claim Reference ID. You can access this by clicking View Statement on the invoice.
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Claim status report: The day after you submit the claim, Halaxy requests reports from Medicare regarding the claim status, which you can retrieve by clicking Get Report on the invoice. For DVA, allow an extra day to receive an update. (Halaxy has no control over when reports are received.)
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Additional time required: If you entered details in the Additional Information field when submitting the claim, a Medicare officer will need to review the claim.
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After Medicare's validation, there are three possible outcomes.
Outcome
Events
Additional info
SuccessInvoice claim status: Lodged / Completed
The claim is successful and passed Medicare's validation. Completed means the claim is fully processed and the rebate has been paid.
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Documents: Medicare provides the Statement of Claim and Benefit Payment (bulk bill) or DVA Processing & Payments Report (DVA), which states the Claim Amount and the Claim Reference ID. You can access these by clicking View Statement on the invoice.
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Claim status: The claim status shown in the statement or report is based on the status of the claim at the time of issuing and is not updated afterwards.
FailureInvoice claim status: Failed
The claim failed Medicare's validation process and it is not submitted for further review.
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Error code: Medicare provides an error on the report, which you can access by clicking Get Report or View Report on the invoice. Use the report to identify and fix problems in the claim, then resubmit the claim. See article: Troubleshoot bulk bill and DVA error codes
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