Table of Contents
This article covers how to resolve, reclaim, and manually receipt electronic claims sent from Gentu.
When a claim is returned with Exceptions in its Processing Report, you can view any issues by clicking on the Exceptions notification within the Reported column.
This will take you to the Unresolved Invoices tab, showing the invoice(s) related to the claim in question.
Click on an invoice to open it and view the line-by-line exceptions for each item.
The method used to resolve the exception depends on the nature of the exception - whether the item was underpaid or rejected.
If a claimed item has been underpaid, you can resolve the exception by simply adjusting the item to match the amount paid by Medicare/the fund.
Click the adjust icon corresponding with the item to open the Adjust Item window. Fill in the details as prompted to adjust the fee so that the item's charge amount matches the benefit paid.
Save/apply the adjustment, then tick the Mark as resolved checkbox, and save out of the invoice.
If a claimed item is rejected, you can amend its details to resolve any exceptions preventing payment, then resubmit it to Medicare or the fund for re-assessment. For a list of some common exceptions and how to resolve them, please see our article on Exceptions.
To reclaim an item:
Once you have addressed any exceptions on the claim, reclaim the item by opening the invoice and ticking the Reclaim Item checkbox corresponding to each item you wish to reclaim.
Then simply press the Reclaim button , as shown below.
Note that when an item is reclaimed, the Reported column for the original claim will update to reflect this by displaying the text "Claim Resent on: [00/00/00]".
The resubmitted claim will return to the top of the Claims Control list under a new Claim ID number, where it will be processed as normal.
Alternatively, if the item was rejected and is unlikely to ever be honoured for payment (for example, if too many of the same services were charged in a 12-month period), then you can adjust the item to write off the outstanding balance, and mark it as resolved to finalise the claim.
To resolve a dishonoured item:
If a claimed item is rejected with an exception that indicates it will never be honoured by Medicare/the health fund, then you can zero out the balance of this item and mark it as resolved so that Gentu no longer considers it outstanding and the claim can move into the Finalised tray.
Open the invoice and click the Adjust icon for the rejected item, and fill in the details.
Press Save to confirm. Once complete, simply tick the Mark as Resolved checkbox and save out of the invoice.
When all exceptions have been marked as resolved, the Exceptions notification will no longer appear for this claim, and it will move into the Finalised tray.
In some cases a health fund may pay a claim by sending a hard-copy remittance advice or statement of payment - for instance, if the electronic Payment Advice wasn't delivered successfully back to your Gentu.
To receipt a claim using a manual remittance advice, navigate to Financials > Organisational Remittance and click on the name of the organisation or fund you have received the remittance from. You should see a screen similar to the one below:
In the example above, the manual remittance paid for 2 of the 4 outstanding items for this patient. You can see where the Total Paid amount has been entered at the top of the screen, and then the individual amounts entered in the Payment column for that item, before saving.
Enter the payment date, payment source, reference and total paid at the top of this screen, then scroll down through the list to locate the patient associated with the given remittance. Please enter the respective payment for each item, then scroll to the bottom of the screen and press Save.
If the claim had exceptions associated with it in claims control, you will need to open the invoice in the patients record to resolve these exceptions. To do this, navigate to the patient, click on the Accounts tab and open the invoice. Tick the Mark as resolved checkboxes and click Save to finalise.
If Gentu isn't able to automatically receipt a claim, then you may see the "Receipting Required" notification appear within the Payment Reference column for that claim.
This is a catch-all message which indicates that Gentu was unable to process a normal automatic receipt for the claim. This can occur for a few reasons - such as if the claim receives a Payment Advice without a matching Processing Report; or if the claim was paid in a bulk remittance that covers several claims from the same fund, and one of the associated claims had issues.
If you see this notification, it means that you must manually receipt via Organisational Remittance in order to finalise the claim. Before doing so, please click on the link within the Payment Reference column in order to open the Payment Advice. In here, confirm that the claim was fully paid. If so, you are fine to proceed with a manual receipt for this claim.
If you require further assistance with resolving a claim, please take a screenshot of the claim's invoice and send this through to firstname.lastname@example.org along with any details about the problem you're experiencing.
If you are unable to locate the invoice for a particular claim, for example if you click on the "Exceptions" notification but the resulting Unresolved Invoices screen is blank, then please email email@example.com with the Claim ID number (visible within the Claim ID column of Claims Control) and any other details about the problem.