HearAid Version 5.0

Claiming Rules

Claiming Rules

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Claiming Rules

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Here are the business rules applied by HearAid when checking OHS claims:

1.Client Voucher number must not be null
2.There must be at least one item
3.Items 670, 930 & 940 cannot be claimed if service date before 1/12/2000
4.Claims for items including a maintenance component (630, 640, 700 & 710) must include left and right 3FAHL
5.If a (L) device is listed, the fitting date must be entered; similarly for (R) device
6.Warning issued if Fitting date/s is/are the same as the claim date
7.Both fitting dates must be before the claim date
8.Fitting records checked: Item 670 cannot be claimed if client has been fitted previously
9.Claims for Item 670 require Rehab Follow-up Date to be entered
10.Item 930 cannot be claimed if client has no fitting
11.Item 930 cannot be claimed if client has binaural fitting
12.Item 930 cannot be claimed less than 12 months after fitting
13.Item 940 cannot be claimed if client has no fitting
14.Item 940 cannot be claimed if client has monaural fitting
15.Items 930 and 940 cannot be claimed less than 12 months after fitting
16.Items 930 and 940 cannot be claimed with an 800 item
17.Missing device code/s for fitting item claimed
18.Only one device code but binaural fitting item claimed (including 760/820 combinations)
19.Two device codes but monaural fitting item claimed
20.Check for missing Authorised Person
21.Check for missing Authorised Person Signed date
22.Check for missing Client Signed date
23.Check Device Code in approved device list
24.Check GST amounts
25.Claims with Authorised Person/Client signed dates in the future are held over until they can be claimed.
26.GST only applied for service dates later than 1/7/2000
27.Item number must not be null
28.Service date must not be null
29.Service date must be later than voucher issue date except for 700 & 710 items (exception allows for legacy pre-1997 vouchers with no date)
30.Service date for non-maintenance items must be before voucher expiry date (12 month valid for vouchers issued before 1/10/2000, 24 months after that date)
31.Voucher number format must be correct
32.Site ID must not be null
33.Practitioner Number must not be null
34.Hearing loss should meet Minimum Hearing Loss criteria

You must enter devices into the Fittings record before you can claim either a 930 or 940 for a relocating client