If you're processing patient claims for Medicare, you're probably well-versed in how things work—the patient pays you for their entire service, and then you send the appropriate information on to Medicare so that the patient can directly receive a portion of that payment back.
Through Cliniko, you're able to process a claim for a patient right from their recently-paid invoice—making things easy for you and your patients! We'll walk you how through it all works—we'll cover the following steps:
- Processing the patient claim.
- Understanding the patient claim form.
- Reviewing the claim's amount and status.
Read on to learn more about patient claiming! (And if it was bulk billing you were after, we've got the details here!)
Processing a patient claim for Medicare
️☝️Note: In order to do this, you'll need to have your Cliniko account integrated with Medipass. Learn how to do that here.
To process a patient claim for Medicare, create the patient's invoice as you normally would, and enter the payment. You'll need to take payment from the patient before you can process the patient claim.
After you enter the payment, when you go back to the invoice, you'll see the option to create a patient claim (below the payment summary):
From there, you'll be able to enter claim details (note that if these details already exist in Cliniko, they'll be populated automatically—but you can manually enter/modify anything—more on that below):
After you enter the claim details, you'll hit the "Continue to payment" button. You'll then be able to review and submit the claim!
You probably have some questions about all the details you have to fill out when recording that claim, though—that's covered in the next section! 👇
Understanding the patient claim form
There are a few moving parts when it comes to processing a patient claim for Medicare! When you start the process, you'll have to ensure that the claim form is being filled out properly. We'll talk you through each part of the form.
This is where you'll input the patient's details: mobile number (optional), first and last name, date of birth, and Medicare number and reference number.
☝️Note: While you can enter the patient's Medicare details on the claim form itself, you'll need to do this each time—unless you enter the Medicare details into the patient file!
If you edit a patient's details, you'll be able to enter both the Medicare number and the reference number in the General information section:
This will allow these numbers to automatically be pulled into the claim form, meaning you don't need to enter them each time you process a claim for this patient.
When the patient's Medicare details are being pulled in automatically, the claim form would look like this (you'd see the patient details at the top, next to the practitioner details):
The claim recipient
If someone else other than the patient is going to be receiving the MBS benefit, you can select "Someone else":
You'll have to include the claimant details here:
Once you've determined whether the patient or another claimant will receive the benefits, you can then move to the next step—referral details.
This is where you'll include everything about the referral. The referrer type, referring doctor provider number, referral date and referral period are all required fields. You don't need to include the referring doctor's name if you don't want to.
These are the services that are being claimed. This will automatically display what was on the invoice:
But you can edit the services, if need be (including removing and adding items):
Continue to payment
This one is pretty self-explanatory, but…you'll need to click the "Continue to payment" button to actually submit the claim!
Finally, before the final submission, you can review the claim. Note that the patient will need to pay in full for the services (this is the amount next to "Out of pocket total"):
Submit, and you're done! That claim has now been submitted to Medicare. 🙌
Reviewing the claim's amount and status
If you need to see the amount that the patient can claim, you can find it on the invoice, after you've submitted the claim:
The claim's status will show up there, too.
You can download/print the benefit form to provide it the patient, and you can also give the patient a copy of their invoice, which should have all their Medicare claim details (which they can keep for reference purposes, if they'd like!).
What you've just read should help you out when it comes to processing those patient—but you may want to know more about other Medicare-related things in Cliniko, or just claiming in general! We recommend checking out the following guides:
- Integrating your Cliniko account with Medipass.
- Processing bulk bill claims for Medicare.
- Processing health fund claims with HICAPS (COMING SOON)
- Troubleshooting problems with Medicare claims (COMING SOON)
Now, while the above walks you through everything from the Cliniko side of things, you may have some questions about your setup in Medipass. You can view their support documentation here!
☝️Note: Medipass offers some different plans; you'll want to ensure that you're signed up for a plan that allows for Medicare claiming. Head here to learn more about the different plans that Medipass offers.
We can certainly help out with any questions you have about Cliniko and Medicare, though. 😊 Send our support team a note via the little "chat" icon in the lower-right, and we'll talk things through!