HearAid Version 5.0

Claims

Claims

Previous topic Next topic  

Claims

Previous topic Next topic  

The Toolbar:

ClaimsToolbar

 

Maintenance Claim will generate a maintenance claim based on the most recent previously claimed maintenance item (including fitting items 630 and 640); no claim will be generated if there are no previous fitting or maintenance items and in that case a maintenance claim must be created in the normal way
HSC Letter will print a covering letter to the client to accompany a maintenance claim form
Maintenance Paid will update the client's maintenance date and, for non-DVA clients, print a receipt for payment of the annual maintenance fee. Click this button when the signed Maintenance Claim form has been received, BEFORE sending the claim to Pending, to ensure the Maintenance Date is updated correctly
Print Claim Form will print a paper claim form for the client to sign
Send to e-Claims Pending marks the claim as "pending" so that it can be included in a batch file for lodgement with Medicare via the internet
Invoice is used by the optional Accounts Interface to generate an invoice in MYOB or QuickBooks for claims with a non-zero Total Client Pays amount

 

The Work Area:

Claims

To Add a new record:

 

1.Click on the Claim form
2.Press the Insert key on the keyboard, or click Insert New Record on the work area toolbar. The Claim Declaration section will automatically expand
3.Enter the Service Date
4.Enter an Item Number. If the item is a Fitting item, the Devices section is displayed and expanded
5.Enter the Site Number (Sites must have already been added in Lists|Sites) if the default site is not correct
6.Enter the Practitioner Number (Practitioners must already have been entered in Lists|Practitioners) if the default practitioner is not correct
7.Tick the Manual Claim if you are entering a Manual Claim
8.Complete the Devices section if this is a Fitting Claim
9.Enter the Authorised Person (Authorised Persons must have already been added in Lists|Authorised Persons) if the default name is not correct
10.Complete the rest of the Claim Declaration section
11.After a claim has been completed the Claim Form should be printed and signed by both the Client and the Authorised person
12.If the claim is to be lodged electronically, click the Send to e-Claims Pending button to add the claim to the Pending list

 

To Edit an existing claim:

 

1.Click on the Form
2.Press Ctrl+Insert on the keyboard, or click Edit on the work area toolbar
3.Modify the details and press Ctrl+S on the keyboard, or click Save Changes on the work area toolbar

 

Print Claim Form

By default, HearAid will group together and print claim items with the same service date or for the items selected by using Ctrl+Click. Occasionally, however, it may be necessary to print separate claim forms for individual items (e.g. when manually claiming a 760/820 item pair. Clicking the down-arrow on the Print Claim Form button displays an option to print a claim form for just the currently selected claim

 

Claim items are colour coded to indicate the claim status

 

Claim Coding

Pale Yellow is a claim that has been saved but not otherwise processed
Orange denotes a Manual Claim which has not yet been marked as Paid
Bright Yellow denotes a claim that has been Sent to Pending and is awaiting further processing
Blue denotes a claim which has been sent to OHS/Medicare electronically but has not yet been Reconciled
Money Green denotes a claim which has been Paid

 

HearAid 5.0 enforces a single-item-per-claim rule, although items sharing the same service date will be grouped onto the printed claim form. This rule has been imposed to reduce claim errors, simplify claim reconciliation and reporting, as well as to avoid problems which have occurred with claim processing at Medicare in the past (for example, the notorious 820/760 combination error). HearAid 5.0 will automatically generate the DVA item codes (777, 888) for clients who have a DVA Number entered in Client Details
If there is a significant 3-Frequency Average difference between the ears, the program will suggest that either a 610 or 810 item may be claimable
Batch Number in the e-Claim section is filled in automatically after the claim has been reconciled

 

Non-Fitting Claim:

ClaimsNonFittingItem

 

Fitting Claim:

Entering a Fitting Item will automatically expand the Devices Section which stores device details for fitting claims. Fitting records will be automatically updated as fitting claims are added. As device codes are selected the program will fill in default Category (if needed for a Top-up fitting), Amount and Tax values, but these values can be modified if necessary. Only devices added in Lists|Devices are available from the pick-lists

 

Claims Devices

 

 

If a fitting claim is made for an ear which does not meet the OHS Minimal Hearing Loss criteria, the user will be warned:

OHSMinimalLossClaim

 

The Claim Declaration section records the information used to complete the Client Declaration on the claim form and also includes the date the Maintenance Fee was paid; for DVA clients the Maintenance Paid date is the same as the Service Date

 

Claim Declaration

 

The e-Claim section tracks claims as they are processed for electronic claiming:

 

1.When the Send to e-Claims Pending button is clicked, the e-Claim box and Pending boxes are ticked and the claim is coloured yellow on the claim list
2.When the claim is added to a Claim Batch, the Pending box is un-ticked and the Processing box is ticked and the claim is coloured blue on the claim list
3.When the claim is Reconciled, the Processing box is un-ticked and, if the claim has been accepted, the Paid box is ticked and the claim is coloured green on the claim list. Rejected items have the error code displayed and are coloured magenta

 

Claims eClaim

 

The Identifiers section stores the Identifiers associated with the claim. OHS Voucher Number records the full voucher number, including the voucher date, as it was when the claim was created

 

ClaimsIdentifiers

 

The Claim Form complies with OHS requirements

 

ClaimForm

 

The HSC Letter template can be modified to suit your own needs by editing the file HSC Letter.rtf in the ..\HearAid 5.0\Reports\Forms folder and modifying the HSC Letter.rtm template in Database|Explorer

 

ClaimsMaintenance

 

HearAid stores a copy of the voucher number that was used at the time the claim item was prepared