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The overall sequence in sending an IMC claim and retrieving payment is as follows:
| 1. | A claim is generated in Access Anaesthetics. Its Status is set to Awaiting transmission. |
| 2. | The claim may optionally be stored prior to transmission. |
| 3. | The claim is transmitted to Medicare and health funds. The claim status set to Awaiting report. |
| 4. | A 'Status request' is transmitted and the status of the claim is retrieved. This may be done on multiple occasions until a processing or payment report is ready. The stages in this process are shown by clicking the <View progress stages> button on the Eclipse page. |
| 5. | If the status request shows that a processing report is ready, a retrieve request is sent. |
| 6. | The processing report is returned. If the claim is rejected, the claim status is set to 'Complete', otherwise it is set to 'Awaiting payment report'. If the claim is rejected the account status is set to 'Eclipse - rejected'. Otherwise the account status is set to 'Payment approved-Eclipse' or 'Review report - Eclipse' depending on whether full payment was approved. |
| 7. | A Status request (ERA) is transmitted to retrieve the ERA Transaction IDs of any available ERAs. |
| 8. | If any ERA Transaction IDs are retrieved, the ERA is requested. |
| 9. | Upon arrival, the ERA distributes payments appropriately to waiting claims. The claim status is set to Complete. The account status is set to Paid in full or Eclipse - review, as appropriate. For group practices, this may happen in data files other than the current one. |
Note
| • | If a claim is rejected or if no payment is due, there will be no payment report. |
| • | For bulk bill claims, there will be no processing report if the claim is accepted without modification. |
| • | For PCI claims, a processing report is returned immediately and the claim is closed. |
| • | For IMC claims, there will always be a processing report, whether or not full payment is approved. |
Report Status
When a Status Request is sent via Eclipse, there are 3 possible values of the "Report Status Code" returned in this transmission. These are ...
PROCESSING - the claim is being processed and a report is not yet available
READY - processing has been completed and a report is available for retrieval
REPORTED - the report has already been retrieved by Access Anaesthetics
If you use the 'Run all transmissions' button on the Eclipse Menu, any reports found to be READY will be retrieved automatically. If a status request is sent again for these claims, their status will appear as REPORTED. Consequently they will not be retrieved again automatically.
Re-retrieving Reports
It is possible to re-retrieve reports manually if required. Reports are usually available for 6 months after they were created.
To retrieve a processing report again, go to the Eclipse tab for the individual account and click the Get Processing Report button. The report will be retrieved again, provided it is still available.
IMC payment reports (ERAs) can only be retrieved by specifying an ERA Transaction ID which is retrieved by a Status Request. This is stored with the ERA when it is retrieved and can be viewed by viewing the ERA report. You can use this ID to retrieve an ERA by clicking the Get Payment Report on the Eclipse page of an IMC account. However, it is unlikely that you will ever need to re-retrieve an ERA report that you already have.
However, you may occasionally need to search for a missing ERA report.
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