This article covers some of the more frequently asked questions regarding claiming in Gentu.
> I received an exception and I don't know what it means. How do I fix it?
Please note that item exceptions are returned directly from Medicare and/or the private health fund, as detailed in the Processing Report window, i.e. they are not returned from Gentu.
Where possible, Medicare/the fund will return self-explanatory exceptions. For example, an exception stating that the referring doctor's provider number is incorrect must be fixed by amending the referring doctor's record in the Address Book before resubmitting the claim.
If you are not sure what an exception means or how to fix it, please check the Exceptions article in our knowledgebase. If the exception is not listed here, you are welcome to contact our support team for advice.
Alternatively you can contact Medicare or the health fund directly to enquire about the exception. In some cases, if the exception is particularly unclear, it will be necessary to speak with Medicare or the fund in order to determine how to fix the exception.
> I submitted a claim with an error or incorrect item on it, or I submitted a claim for the wrong patient. How do I cancel the claim?
It helps to think of electronic claims as similar to emails: once you have sent an email, deleting or changing the email on your end will not delete or update the email on the recipient's end.
Electronic claims are similar - if you were to delete a claim or or change its details after submitting it, the receiving entity (Medicare, DVA or the health fund) would have no knowledge of this and would continue to process the claim with its original details. This applies to all Medicare, DVA, health fund, and private patient claims.
Once a claim is submitted, Gentu will lock the claim in state for 14 days (two weeks) while it awaits its Processing Report. While the claim is awaiting its Processing Report, it is not possible to make any changes to the claim.
If you need to cancel or amend a claim because it was sent in error, you must contact Medicare or the health fund and ask them to cancel or reject the claim on their end. When the claim returns to Gentu as rejected, you can cancel the claim (by adjusting each item's fee to $0 and marking each exception as resolved) and then re-raise the invoice for electronic submission.
> Gentu says I haven't received a Processing Report for a claim in 14 days. Should I resubmit the claim/batch?
Medicare specifies that it can take 14 days (two weeks) for their system to generate an electronic processing report and return this to you, however in some cases it can take longer. Gentu regularly checks for a report for 14 days after submission. If this period concludes without a Processing Report being found for the claim, then Gentu will flag the claim with an error in the Sent column of Claims Control. Clicking on the Error notification will take you to a new page from where you can resubmit the claim.
If you receive this report timeout error, it is imperative that you contact Medicare before resubmitting the claim. In some cases, Medicare will have received and processed the claim as normal. If you resubmit the claim while Medicare is or has processed and paid for the original claim, then this will result in the duplicate claim being rejected, and it will be necessary to manually receipt it.
If Medicare advises they have received the claim, you can request a manual remittance advice, and use this to manually receipt the claim.
If Medicare advises they have not received the claim, then you are fine to simply click the Resubmit button in the top right corner of the error page to resubmit the claim.
> When I click on the "Exceptions" notification, Gentu takes me to Unresolved Invoices, but the screen is blank / I can't see the patient. What do I do?
If you click on the "Exceptions" notification but the resulting Unresolved Invoices screen is blank, then please email firstname.lastname@example.org with the Claim ID number (visible within the Claim ID column of Claims Control) for further assistance.
> The health fund have overpaid a claim. What should I do?
Occasionally it may occur that an account is overpaid by the health fund by a few cents or dollars. If you are happy to accept the overpayment you can adjust the invoice's item(s) to match what was paid by the fund.
We recommend that you contact the health fund to notify them of the overpayment and to confirm that you are using the expected fees going forward.
> How can I unbatch an invoice, so it doesn't get sent in a claim at the end of the day?
At any time prior to 10pm (the time when queued invoices are automatically batched and sent), you can unbatch an invoice to prevent it from sending using the steps below.
- Find the patient
- Open their Account tab
- Open the invoice in question
- Click on the Unbatch button.
This will remove it from the invoices waiting to be transmitted to Medicare or DVA. If the invoice has already been sent, this option will not be available. You will need to wait for the Processing Report to be returned from Medicare or DVA before it can be modified in any way; alternatively, you can contact Medicare directly and ask them to reject the service.
> I need to bill a hospital for inpatient services. Where can I add the Facility ID/Hospital ID?
You can add the hospital's Facility ID via the Address Book. Open the Hospital tab and search for the hospital here, then select it to open the details page (alternatively, select Add > Hospital to add a new hospital record). Enter the Facility ID in the relevant field, then save out.
If you're not sure of a hospital or clinic's facility ID, you can check this Department of Health page - see the links at the bottom of the page which let you download a list of known facility IDs.
> I cannot add a 51300 or 51303 to my invoice - Gentu says the item number doesn't exist. How do I bill an assistant item?
It is not possible to manually add MBS items 51300 or 51303 to an invoice. Instead, when you wish to bill for or as an assistant, you can use the Assist Item button on the invoice (after adding all surgical items to the invoice). Gentu will automatically calculate the appropriate assistant item and fee based on the options you have selected. For instructions on billing for or as an assistant, please see this article.
> How do I bulk bill a patient if they are a child or a minor?
To bulk bill a child (or a minor/ward); you'll simply need to ensure that the patient's parent or guardian is set as the primary account holder.
Add the parent or guardian as an account holder via the Address Book (Add > Account Holder).
Then, open the Patient Details tab and add the parent/guardian as an account holder for this patient under the Account Holders heading.
If the patient has a 'self' type account holder already selected, you can then select and Unlink this account to ensure the parent/guardian is the primary account holder by default. (If you do not remove the 'self' account holder, you'll need to manually select the parent/guardian as the Addressee when you invoice this patient.)
> What is the Fund Payee ID?
The Fund Payee ID is a reference number unique to each practitioner which identifies them to the health fund. Certain funds (such as BUPA and Medibank Private) require the fund payee ID to be sent in the claim metadata in order to process your claims. If you are not sure of your fund payee ID, you can check the registration documentation supplied to you by the fund, or contact the fund directly.
You can add the Fund Payee ID for a health fund by navigating to Settings > Health Funds. Select the fund in question, then scroll down to the Practitioner Details heading and select the doctor's name. In the details window which opens, you'll see where you can enter the Payee ID.
> What is a health fund agreement?
A 'health fund agreement' is an arrangement between a practitioner and a private health fund. Under a health fund agreement, a doctor can use the private health fund's fee schedule to set the item charge, and the health fund pays the gazetted rebate amount. (This is true for both No-Gap and Known Gap claims.)
If your doctor doesn't have a health fund agreement, they can still send claims to the health fund. However, the health fund will treat the claim as a private-type bill, and you will receive a reduced rebate amount from the fund in payment.
The doctor can arrange to enter a health fund agreement by contacting the fund directly.
> I can't see the "Reclaim Item" checkboxes needed to resubmit the claim.
This can occur if the claim is partially paid, but still has exceptions in the processing report - for example if Medicare pays their portion of an item, but the fund rejects the item due to other issues. In this case, usually the best thing to do is to print the invoice and submit it manually to the health fund for payment. Once the payment is received the claim can be receipted via Organisational Remittance. You are also welcome to contact our support team (email@example.com) for advice.
> Can I send a claim via ECLIPSE if a patient does not have a Medicare Card?
It is not possible to send a claim via ECLIPSE if a patient does not have a Medicare card due to the way the ECLIPSE channel has been setup. If you encounter this situation, you will need to send the claim manually to the Health Fund.