Residential care claims

Check all events have been updated in the ACPP and any required documents have been uploaded. This may include supporting evidence for oxygen supplement and enteral feeding supplement.

Check that your care recipients have been entered into the correct approved place – either a general or extra service place, to ensure over occupancy errors don’t occur.

When submitting a departure event through your claim, check the correct departure reason has been used as this reduces payment delays and errors.

You don’t need to give us a breakdown of the costs, fees and invoices but you must keep a record for compliance checks.

Log in to the ACPP. If you have multiple services, go to the Service ID bar to ensure you’re in the correct service.

You’ll need to have the required level of access to follow the steps to make a claim.

To avoid errors, make sure to:

• use your Service National Approved Provider System number (NAPS) ID, not your organisation’s - you can find this in the Service details bar in the ACPP
• check all event types, reason codes and dates have been entered correctly.

1. In the open claim, check all the events display as accepted in the Status column. You can use the Search bar to search for all records that contain that keyword. 
2. Use the Legend button to display the explanations of the various codes.
3. Select the number of records to be displayed from the Show records drop down list. This can be found on the bottom left hand corner.

You can go to a different page by selecting any of the following:

• First, Previous, Next or Last options.
• The relevant page number.
• Finalise the current claim.

To finalise a claim ensure you’re working in the correct service using the Service ID bar.

Once you’re in the correct service:

1. Select Current claim in the quick links menu.
2. Once the Current claim screen has loaded, select Finalise claim.
3. A warning message will be displayed to notify you about possible outstanding events still being processed.
4. You can select:
   • No, this will cancel the claim finalisation process
   • Yes, the portal will display the Certification and authorisation screen asking if you have read, understood and accepted the terms of conditions prior to finalising the claim.
5. Check the box labelled I accept the terms and conditions and then select Submit to finalise the claim.
6. If you choose Back, do not accept the terms and conditions or do not finalise the claim you’ll return to the Current claim screen.
7. Validations will be performed to ensure mandatory information has been submitted for the required care recipients. You can only claim the amount of general and extra services places that have been approved by the Department of Health and Aged Care. Otherwise, you will get an Over occupancy error. You can generate Over occupancy reports.
8. If you’ve successfully submitted the claim, you’ll see a Successful receipt screen. If you return to the All service claims screen, you’ll see a status of Processing next to the claim you have just finalised.

An over occupancy report will appear only if the selected service is over occupied when finalising a claim.

If a service has claimed more extra service or general service places than has been approved by the Department of Health and Aged Care this will generate an over occupancy report.

You’ll be able to generate a report that shows you exactly:

• how many places were over occupied on any given date that month
• which care recipients were in the selected service on any given date that was over occupied during that month.

Clicking through the over occupancy information will enable you to amend care recipient events to address the issue. You can’t finalise a claim until the over occupancy is corrected.

To generate an over occupancy report:

1. Complete steps to finalise a claim.
2. If a service is over occupied, you will be taken back to the Current claim screen. On this screen you’ll see:
   • an error message showing the details of the over occupancy
   • a green Over occupancy report button in the bottom right hand corner of the screen.

The error message will be slightly different dependent on whether the over occupancy was caused by:

• more care recipients than available places were entered in the current claim month
• an adjustment for a previous claim month.

Use the green Over occupancy report button to access the report.