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Karisma and Medicare Online

July 2010

Karisma has now offered users assured and direct integration with Medicare Online for almost three years. The development of our flagship solution in line with Medicare Online's evolution has been a learning experience for all involved at Kestral. The changeover from Medclaims, the previous system, was enormous in terms of both programming requirements and the re-training of users.

As you upgrade to Karisma V2.0.9, you will notice a slight change within the Medicare Online requirements. Kestral has actively upgraded Karisma's in-built functionality to the very latest version of Medicare Online. The Karisma support staff at Kestral have taken the time to outline a set of Frequently Asked Questions on Karisma's new Medicare Online functionality.

Below you will find common questions and the solutions that will enable you to resolve any issues you may have, internally to your organisation.

Q1: Error Message: The response from the central site was not received within the permitted response time.

This error usually means that there is a problem on the Medicare Australia systems and they have not been able to process the information that you are trying to send.

Log on to the Medicare Australia website and have a look at the status of their systems:

http://www2.medicareaustralia.gov.au/pext/ECLIPSEMonitor/external/eclipse_status.jsp

Q2: Error Message: The processing report for this bulk-bill claim is not yet available or no longer available.

This error message will appear when you are trying to retrieve a batch from Medicare Australia. There are a number of causes of this error message:

  • You are trying to retrieve the batch information before it has been processed. Check the date that you submitted the batch. Medicare Australia will usually take a couple of days to process bulk bill batches. DVA batches sometimes take a little longer.
  • You are trying to retrieve the batch information for a batch that was submitted and paid over 6 months ago. Medicare Australia delete the batch information after 6 months and the report is no longer available to retrieve.
  • The most common reason for this error is that the servicing (invoicing) provider you have submitted the batches for is not registered correctly at Medicare Australia. In this case, Medicare Australia will not return a report but will contact your site and explain the situation. They will then require you to submit the necessary paperwork on behalf of the radiologist and retransmit the batch. For more information, please refer to the Kestral Knowledge Base document - http://kb.kestral.com.au/questions.php?questionid=65
  • If you do not hear from Medicare Australia, it is most likely that the contact person for your site who originally submitted the paperwork no longer works for your organisation. In the first instance, give Medicare Australia a call and confirm that this is the reason.

Q3: An invoice has been rejected by Medicare Australia, so how do I send more information regarding the claim, such as body region?

Occasionally, Medicare Australia requires additional information regarding a claim before they will pay it. Without any paperwork to submit, it is harder to convey this information. In order to meet this requirement, you will need to add information to the Default Claim Service Text field in Karisma.

Edit the request for the required invoice. Place your mouse cursor in the middle of the service type with which you wish to associate the additional information and right click. Select Edit Selected Service. Move to the Claims Details tab and you will find the field at the top of this dialog. Click OK on the Edit Service Details dialog and the Request Details dialog.

Q4: How do I balance the batch money within Karisma against my bank statements?

When you select the action within Karisma to Retrieve Report from Medicare Australia, Karisma will present to you the Add Payment Details dialog. This dialog will be completed with the information supplied by Medicare Australia. The important information is:

  • Received Date: this is the date on which Medicare Australia requested that the Reserve Bank of Australia deposit the funds into your nominated bank account.
  • Reference Number: when Medicare Australia deposit the money into your bank account, they will send through this reference number – this number should be displayed on your actual bank statements.
  • Please note that it is possible that multiple batches may be settled with a single payment from Medicare Australia. Therefore, multiple entries with the same reference number will appear on the payment batch lists in Karisma – total all of these to equal the deposit line on your bank statements.

Q5: How can I determine what information will be sent through to Medicare Australia?

In the processing of the Medicare and DVA batches, Karisma does a large amount of processing in the background and pulls together a large amount of information. Sometimes you may need to review the information to be sent through to Medicare Australia before actually hitting the Submit button.

From the Current Unclaimed Invoice Batches screen, select Claim Selected Batches. If there are no issues with the batch, Karisma will present the Medicare Online Batch Claim Submission dialog with the message ‘This invoice batch is ready for submission’. If you click on this message, it will display the submission information for the batch, patient and invoice.

If you have any further questions not answered here, feel free to contact your Kestral Account Manager who will be more than happy to help. In the meantime, be on the lookout for the exciting development of Karisma integration with Eclipse. The development and testing phase of this much sought after functionality is set for completion in the not too distant future.