MBS claim processing and payment reports - Health professionals

Medicare Easyclaim reports

Bulk bill processing and payment reports provide information about a claim and the services within that claim. This includes:

details of a payment deposited
bank details
a list of claims or transactions covered by the payment
details of all accepted and paid bulk bill claims.

The reports will be available within 2-3 working days.

The reports can be accessed through either:

HPOS
the bulk bill integrated reporting solution supported by the integrated practice management software.

Contact your software developer for issues accessing reports through your practice management software.

Accessing reports through HPOS

To access your Medicare Easyclaim reports through HPOS, you’ll need a Provider Digital Access (PRODA) account. If you don’t have one, you can register for a PRODA account.

Log on using PRODA

Only the Payee Provider can access the reports.

Steps to view processing and payment reports

Sign in to HPOS.
Select Reports from the main menu.
Select Medicare bulk bill reports.
Select Report type, either Payment or Processing.
Enter the Payee provider number. If multiple providers are working within the practice, you can use the Servicing provider number field to filter a particular servicing provider. This isn’t required if the servicing provider is also the payee provider.
Enter the Lodgement date from and Lodgement date to fields using DD/MM/YYYY date format.
In the Claiming method field, select either Easyclaim or Webclaim from the drop down box.
Select the Format type you wish to receive the report in - PDF or Excel
Select the Search button.
When Search is selected, a new page will display showing the report. This file can then be printed or downloaded.
If you select Excel, you’ll be able to open or save the file and sort columns and rows as needed.
If the report is unavailable, you’ll see an error message showing ‘The requested report is not available or the processing report has no exceptions’.

Bulk bill processing report

This report shows all successfully submitted transactions or claims that have been processed with exceptions.

Exceptions are claims that have an assessing Medicare reason code and claims submitted where there’s a problem with the patient’s Medicare card. Transactions or claims that were processed without any exceptions or errors aren’t included in the processing report.

Medicare card problems

A value may appear on the bulk bill processing report against a claim indicating a problem with a submitted Medicare card.

The following table shows these values and the problem it represents.

Value	Problem
A	Patient identification amended.
I	Patient Medicare issue number changed.
C	Patient Medicare number changed.
W	Patient card used will expire shortly.
S	Patient card expired. Future services may be rejected.
X	Old Medicare issue number for patient. Future services may be rejected.

Bulk bill payment report

This report shows all transactions or claims that were successfully submitted and paid. This report also shows the:

payment amount for all services within a claim
total payment amount to the provider for the same payment run in the report
date the payment was made.

ECLIPSE reports

You can use ECLIPSE to retrieve reports using the retrieve report function.

The report’s content and format depends on the function and ECLIPSE release installed on your PMS.

There are several types of reports you can retrieve using ECLIPSE.

Get Participants report

The Get Participants report includes details of all ECLIPSE enabled private health insurers, including their:

fund brand ID
trading name
contact number
date record last updated.

You should request reports regularly so you have access to the latest information and services. New private health insurers come on board regularly. Existing private health insurers upgrade and provide more features in new ECLIPSE releases.

You’ll get a real-time response when requesting a Get Participants report.

Status report

A status report provides the status for submitted transactions. It lets you know if the transaction has been validated and assessed, and if a report is available. The response depends on the state and type of transmission.

This table shows the responses you get from a status report and what they apply to.

Response	Detail
Processing	patient verifications claiming eligibility checks
Ready	claiming eligibility checks remittances
Reported	claiming eligibility checks remittances

You should request a status report before attempting to get a report. If you try to get a report that isn’t ready you’ll get an empty report.

You can request the report or it can be provided in response to a submitted transaction. It depends on your software.

Claim processing report

A claim processing report tells you the outcome of your completed claims. You can get these reports any time. You can request them more than once within 6 months of the original request.

The presentation and structure of the report depends on the type of software your practice uses.

The status response will indicate if a report is available. The response will look different depending on the transmission type.

For billing agent claims, you can only get the report after the private health insurer pays their benefit.

Online eligibility processing report (OEC)

An OEC includes information for any out-of-pocket hospital expenses, prostheses and medical services.

If the system accepts the OEC we and the private health insurer will assess the claim. You can get results within 20 minutes of the system getting the OEC.

If the results aren’t returned to the ECLIPSE hub within 20 minutes, it means the request is cancelled.

Reports are available for 7 days.

ECLIPSE Remittance Advice (ERA) report

An ERA report includes payment information for unpaid in-patient medical claims (IMCs) that were submitted under these claim types:

AG - agreements
SC - approved gap cover schemes
MB - billing agent submitting claims to private health insurers and us
MO - billing agent submitting claims to us only.

ERA reports aren’t available for IMC patient claims because the patient or claimant is responsible for the account.

The private health insurer will create an ERA when they deposit the EFT funds into your bank account.

If you have more than one payee submitting per location, you’ll get a remittance advice for each payee.

You can get an ERA report any time. You can request them more than once within 6 months of the original request. ERA reports are only available if the private health insurer supports this function.

Webclaim reports

A processing report is available one business day after your claim’s finalised. You don’t need to subscribe to get these reports, they’ll be sent to you through Messages in Webclaim.

Processing and payment reports

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