4 min read · Published
In short
- Every patient is verified with Medicare and their health fund before an estimate goes out.
- Claims are lodged through ECLIPSE automatically, and their status is checked four times a day until they are paid.
- If a claim is rejected or keeps failing, the reason comes to you, and the claim waits in a Claim Errors list.
- Workers’ compensation, traffic accident, overseas, defence, third-party, self-insured, cosmetic and public-in-private accounts are covered too.
Checked before it is claimed
Every patient is verified with Medicare and their health fund when the encounter is created, so cover and payer are settled before an estimate is issued. A patient’s DVA cover category is shown in their details, and setting an encounter to outside hospital with a private health fund selected asks for confirmation first, so the insurance type can be corrected before it causes a rejection.
Lodged through ECLIPSE
Submit the bill on the day of the procedure. Anaemate holds the claim for a correction window, 24 hours unless you change it, or sends it straight away if you choose, then lodges it through ECLIPSE to Medicare, the private health funds or DVA, and tries again automatically if a lodgement fails.
When a claim needs attention
Medicare and fund explanation codes are captured with each claim. If Medicare rejects a claim because the patient’s details don’t quite match, Anaemate verifies them again, corrects them and lodges the claim once more. If a claim is rejected for another reason, or keeps failing, the practice team is emailed the reason and the claim appears in the Claim Errors list until it is resolved. If a patient’s own claim is rejected, the patient is told.
If a code needs to change on an unpaid invoice, it can be edited in place: the invoice keeps its number, and changes lock once a payment is confirmed.
Followed through to payment
Four times a day, Anaemate checks the status of each claim and the remittances that pay them. Remittance advice is matched to the bank deposit that paid it, and the benefit received is compared with the benefit claimed: anything outside your variance threshold is flagged as underpaid or overpaid, and the practice team is emailed.
Every claim type
Beyond ECLIPSE, Anaemate bills every other kind of anaesthetic account in the same place.
- Workers’ compensation, with invoices emailed to the insurer as soon as the encounter is submitted
- Traffic accident claims and third-party payers
- Defence
- Overseas and self-insured patients
- Cosmetic procedures
- Public-in-private, at 1% plus GST
In the platform
Billing and claims