This article covers some of the more frequently asked questions regarding claiming in Gentu.
Please click on each question heading to read more.
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 the same - if you were to delete a claim or or change its details after submitting it, the receiving body (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.
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.
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.
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.
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.
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.
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.
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.
Please note, the Gentu team does not make changes to the organisational fee schedules available in Gentu. After receiving the schedule files from the relevant body, the files are are checked for integrity and then uploaded without changes to ensure the accuracy of the fees you are charging.
If you are concerned that you are consistently being underpaid for the item, it is recommended that you contact the organisation in question to confirm that the correct fee is being charged. If the organisation advises that the correct fee is different to that shown in Gentu; we recommend that you request written documentation from the organisation advising of this change. We ask that you please then forward this documentation through to firstname.lastname@example.org so we can address this.