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Blue Chip Training Guide Page 151 of 193
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Blue Chip Training Guide
Electronic Patient Claiming
Patient Claiming Scenarios
Scenario 1: A gap payment, manually sent
Patient makes a part payment (gap payment) to the practice and the claim is manually sent to
Medicare Australia Patient Claiming.
Reimbursement:
A Medicare cheque with the doctor as the payee is sent to the patient. The patient then
forwards the cheque to the practice. If the cheque is not presented to the practice within 21
days, the practice should contact the patient initially. Depending on what has transpired, the
patient should then either present the cheque to the practice OR contact Medicare Australia to
have the original cheque cancelled and a new cheque redrawn. The cheque will then be sent
to the patient to be forwarded on to the practitioner.
There may be an alternative logic path; however this would differ for individual
circumstances.
Scenario 2: A gap payment, electronically sent
Patient makes a part payment (gap payment) to the practice and the claim is electronically
sent to Medicare Australia Online Patient Claiming.
Reimbursement:
A Medicare cheque with the doctor as the payee is sent to the patient. The patient then
forwards the cheque to the practice. If the cheque is not presented to the practice within 21
days, the practice should contact the patient initially. Depending on what has transpired, the
patient should then either present the cheque to the practice OR contact Medicare Australia to
have the original cheque cancelled and a new cheque redrawn. The cheque will then be sent
to the patient to be forwarded on to the practitioner.
If after 90 days a cheque has still not been presented to the practice, Medicare Australia runs
a search on cheques that have not been cashed. Medicare Australia will cancel non cashed
cheques and credit the practitioners’ account electronically.
Scenario 3: Full payment, electronically sent
Patient pays the invoice in full and the claim is sent electronically to Medicare Australia
Patient Claiming
Reimbursement:
After processing, the patient is electronically paid the claimable amount if they have first
registered their details with Medicare Australia.
Otherwise the patient will be reimbursed by Medicare cheque.