Cliniko & Medicare: Frequently asked questions

Got questions about our Medicare integration? We have answers!

Emily avatar
Written by Emily
Updated over a week ago

If you're processing Medicare claims through Cliniko, you probably have some questions! Luckily, we have some answers. 😉 Read on for answers to some frequently asked questions about Medicare.

Why do I need to have a Tyro Health account to process Medicare claims?

Tyro Health (formally Medipass) is a digital health payment company that's focused entirely on claims and payments. They support the largest range of claiming options that are available in Australia—so no matter what a patient might be eligible to claim for, Tyro Health can handle it. 

We've integrated with Tyro Health because the tools they've built for online claiming are incredibly powerful, and we've worked directly with their team to ensure that the way Cliniko "speaks" to Tyro Health is seamless (which also means a seamless experience for you and your patients). Plus, they have a team of amazing people supporting the claiming side of things—which means we can continue spending our time supporting the Cliniko side of things!

I've just signed up for a Tyro Health account, but I can't create any claims. What's wrong?

After signing up for a Tyro Health account (or any system that offers online Medicare claiming), it can take several days for your account to be verified and approved for online claiming. 

Why? Medicare requires time to process the forms that you (as a provider) send to them to get set up for online claiming. Tyro Health will help you out with these forms! After submitting them to Medicare, it will be a bit of a waiting game—while application times vary, you can typically expect roughly five business days for approval. 

Tyro Health outlines this process right here—if you have specific questions on it, their team will be able to help you out!

Why is a claim asking for a Medicare Location ID or Minor ID?

Cliniko does not integrate directly with Medicare Online Claiming. Due to this, Cliniko doesn't have a location or minor ID.

This can be found in your Tyro Health account, and they have an article about it here.

Do patients need to download an app?

No—patients do not need to have an app to if you're using Tyro Health (formally Medipass) to process online Medicare claims. 

How long will it take for claims to be approved?

If it's a patient claim, you should find out the same day (or, depending on the patient's banking details, it may be the following business day). If it's a bulk bill claim, it would be approved the next business day.

What happens if a claim doesn't go through?

If a claim is denied for any reason, you will see a message explaining why. This would occur immediately for a patient claim, and the next business day for a bulk bill claim.

Do patient claims need to be processed on the same day the patient is billed?

No—you can process the claim later, if necessary. Just be sure to put the correct date of service on the claim form!

Will an invoice be marked as closed when Medicare pays for a bulk bill claim?

It depends on your settings. If you've allocated a payment type to Medicare in your Tyro Health integration settings, then Cliniko will be able to tell when Medicare has remitted payment, and close the invoice. If you have not allocated a payment type to Medicare, then you will need to manually mark those bulk-billed invoices as paid.

Can I charge a gap payment when bulk billing Medicare?

In short, no. When processing bulk bill claims, Medicare rules state that the claim must be submitted to Medicare for the whole value of the service. Medicare will then process the claim and pay you (the clinic) the relevant rebate.
If you are taking any payment from a patient, you should be processing a Patient claim instead. A patient claim involves taking a payment upfront from the patient and then submitting the claim to Medicare, who will rebate the relevant amount directly back to the patient.

How can I get referral details to show up automatically on a claim?

In order for referral details to automatically show up on the claim form, you'll have to ensure that you first create a case for this (and any related) appointments—as well as add referral details to the case

It's important to note that the referral details need to be included on the case for a Medicare claim—simply having a referring doctor in the patient's details won't be enough.

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