Third Party Insurer Claims

In Patient Details, you can record the details of any claims that the patient has lodged with a third party - for example, WorkCover claims or TAC claims.

Third party claims are separate from/not related to health fund claims.

For information on billing a private health insurance fund, please see this article.

Creating a third party claim

To record a third party claim for a patient, open Patient Details and find the Third Party Claims heading. Here, click the + icon to add a new claim.

Claim Details

• Claim Status: 
  • You can set the Claim Status as either Active or Closed.
  • A new claim would be Active until its resolution with the third party, at which point you can open it and mark it as Closed.
  • You can also use the Closed status to, for example, record a history of patient’s previous/resolved claims.
    
    
• Insurer: 
  • The insurer is the entity who insures the patient or the patient’s employer. WorkCover and TAC are both examples of insurers.
  • Before you can select an insurer, you will need to add them to the Address Book. An insurer can be either an Account Holder or a Contact.
  • It is recommended to add any insurers to the Address Book as a Business type Account Holder.
    
    
• Injury: 
  • The injury is where you can record the reason for the third party claim’s creation.
  • The injury reason must be recorded in order to save the third party claim.
    
    
• Claim Number: 
  • When the claim is initially submitted to the insurer, in most cases they will provide you with the identifying Claim Number for this claim.
  • Once you have been notified of the claim number, you can record it here. 
• Injured on: 
  • This field is where you can record the date that the injury occurred.
    
    
• Case Manager / Phone / Fax / Email: 
  • In most cases, the insurer will assign a case manager to handle the patient’s claim.
  • You can record the case manager’s details by typing their details into the respective fields. 
    
    
• Employer: 
  • In this field you can record the patient’s employer.
  • Similar to the insurer, you will need to add the employer to the Address Book before they can be selected here.
  • An employer can be added as either an Account Holder or a Contact within the Address Book.

Once you've added all the details here, press Save to save the claim.

Billing a third party claim

After you've created a third party claim, you can link it to an invoice when billing a third party entity (using the Other account type).

Note that the claim must be active (not closed) in order to link it to an invoice. 

To link a third party claim to an invoice:

1. From the patient's file, select Add > Invoice.
2. Select the Other account type.
3. This will reveal a Claim drop down menu, underneath the Inpatient/Outpatient radio buttons.
   
4. Select an active claim from the Claim menu.
5. Gentu will automatically populate the necessarily details into the invoice, such as the Addressee (the insurer) and the case manager, (assuming they were added at the time of creating the claim).
6. If you did not add an insurer at the time of creating the third party claim, then you can manually search for the account holder within the Addressee field. 
   
7. You can now proceed to add the billing items and other details to the invoice as you normally would.
8. Save or Print the invoice.

When you print the invoice, Gentu will address the invoice to the Insurer, attentioned to the Case Manager that you have selected, if any.

Gentu will also print any of the claim details which are available, including the case number, injury date, and the employer and employer's address.

FAQ

> Can I print a WorkCover certificate for the patient?

At the moment it isn't possible to print a WorkCover certificate from Gentu, however we hope to have this feature available in the future.

> Can I add a third party claim even if I don't have the Claim Number yet?

Yes, you can save a claim even if you don't have all of its details yet. The minimum information you need to save a third party claim is the name of the injury.