Claim types

Online Patient Verification	OPV	Real time verification of a patient's Medicare and health fund membership.
Bulk Bill claims	BB	Claiming the Medicare rebate as full payment of an account.
Patient Claims	PCI & PCS	Where a patient has paid the account and requests that the practice submit a claim to Medicare on their behalf. (Interactive or store/forward.)
Inpatient Medical Claims	IMC-AG	Medicare and health fund claims where the provider has signed an agreement with the health fund.
	IMC-SC	Medicare and health fund claims using gap cover products where the provider is operating under a scheme (no signed agreement).
	IMC-PC	Where a patient has paid the account and requests that the practice submit a claim to Medicare and health funds on their behalf.
Eclipse remittance Advice	ERA	Electronic payment advices for IMC claims.
Veterans' Affairs	DVA	Paperless electronic claiming for Veterans' Affairs patients. (Not yet available in Access Anaesthetics.)

Reports are retrieved in due course after submission of claims as described here.

The following are those account conditions that best lend themselves to electronic claims. A complete list is given below (recommended types shown in blue text). Additional patient followup may be required for some electronic claims.

Medicare only. The patient signs a Medicare assignment form and the doctor can claim the Medicare rebate electronically (BB). The patient does not pay anything, and does not have to make a Medicare claim.

Standard fee. The patient pays the full fee and the doctor sends a claim to Medicare (PCI) so that the patient does not have to apply for a rebate independently. This is only practical if the patient pays the fee in person as the doctor needs to say to the patient "Would you like me to send this claim to Medicare for you?".

No gap fee. The claim is sent electronically (IMC-SC). A separate co-payment account is sent in the usual way if appropriate.

Standard fee. The patient pays the full amount and the doctor sends a claim to Medicare/fund (IMC-PC) so that the patient does not have to apply for rebates independently. If the patient pays the gap only, they will receive cheques made out to the Dr. This is only practical if the patient pays the fee in person as the doctor needs to say to the patient "Would you like me to send this claim to Medicare/health fund for you?". If the patient has paid the gap only, the onus is on the patient to forward the rebate cheques to the doctor. This may require additional followup. The patient must also read and agree to the Consent and Declaration.

Fee type	Acct to	Patient pays	Eclipse Claim	Notes
Uninsured patients
Medicare only	Pt	No		Pt applies to Medicare for rebate which is sent to Dr.
Medicare only	Pt	Yes		Pt applies to Medicare for rebate for self.
Medicare only	No	No	BB	Pt signs Medicare assignment slip at time of service.
Standard fee	Pt	No		Pt applies to Medicare for rebate which is forwarded to Dr with balance owing.
Standard fee	Pt	Yes		Pt pays full amount and applies to Medicare for own rebate.
Standard fee	Pt	No	PCI	Rebate cheque received by Pt who must forward cheque to Dr plus balance owing.
Standard fee	Pt	Gap	PCI	Rebate cheque received by Pt must be forwarded to Dr. (Gap already paid.)
Standard fee	Pt	Yes	PCI	Pt receives Medicare rebate cheque for self.
Patients with private health insurance
No gaps	Fund	No		Fund pays Dr full amount.
No gaps + co-payment	Fund+Pt	Copay		Fund pays Dr fund rebate. Separate acct forwarded to Pt for co-payment.
No gaps	Fund	No	IMC-SC*	Fund pays Dr full amount.
No gaps + co-payment	Fund+Pt	Copay	IMC-SC*	Fund pays Dr fund rebate. Separate acct forwarded to Pt for co-payment.
Standard fee	Pt	No		Pt applies to Medicare and fund. Rebate cheques received by Pt to be sent to Dr along with balance owing.
Standard fee	Pt	Yes		Pt pays Dr in full. Pt applies to Medicare and fund to obtain rebates for self.
Standard fee	Pt	No	IMC-PC	Rebate cheques received by Pt who must forward cheques to Dr plus balance owing.
Standard fee	Pt	Gap	IMC-PC	Rebate cheques received by Pt must be forwarded to Dr.
Standard fee	Pt	Yes	IMC-PC	Patient receives Medicare/fund rebate cheques for self.

Standard fee refers to any fee other than Medicare only or health fund no-gaps fee.