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There are some billing items which presently aren't able to be claimed through Gentu's electronic claiming systems. This article outlines these items with details of alternative options to claim them.
Gentu is developed principally for medical specialists. At the present time Gentu is not capable of transmitting items which relate to general practice and many items which relate solely to general practice are not included in our fee schedules.
Invoices with GP items may appear to have transmitted successfully in a claim, but in most cases the invoice will be rejected by Medicare without being processed.
In the event that your practice needs to transmit these items, it will be necessary to transmit these through the PRODA (Provider Digital Access) system - see below for more details on this.
Dental items cannot be transmitted in online claims from Gentu at this time.
Fees for dental items are not included in the DVA schedule, so any dental items added to a DVA invoice will be listed with a fee and rebate of $0.00.
In the event that your practice needs to transmit these items, it will be necessary to transmit these through the PRODA (Provider Digital Access) system - see below for more details on this.
Gentu currently does not calculate the DIMSR (Diagnostic Imaging Multiple Service Rules) for diagnostic items. As such it is not possible to claim these diagnostic items through Gentu.
These diagnostic items include any Category 5 services under the MBS, and cover items with numbers from 55000 through to 64999. For more details on these items, please refer to the MBS website.
In the event that your practice needs to transmit these items, it will be necessary to transmit these through the PRODA (Provider Digital Access) system - see below for more details on this.
We do intend to include the ability to claim these diagnostic items as part of a future release of Gentu.
In some scenarios you may wish to invoice a patient and direct them to claim from Medicare, rather than electronically submit the claim on their behalf.
In these cases it may be worth mentioning to the patient that many specialist items are not able to be claimed via the Medicare Online service. Patients will need to either claim in person or via the Express Plus Medicare mobile application, which allows users to claim a wider array of items.
Items with derivative fees (items whose fee is based on a percentage of an associated item) such as items 99, 112, or 31340, are not able to be electronically claimed in Gentu at this time.
As these items' fees are variable, they do not have a set rebate amount (instead showing a $0 rebate), however a rebate amount is required in order to electronically claim an item.
If you do need to bill items with derivative fees, it is recommended to print the invoice and mail it to the body in question (Medicare, DVA or the health fund) for processing, or to use the PRODA (Provider Digital Access) online portal.
Anaesthetic billing items, those in MBS Group T10, are not able to be electronically claimed from Gentu. This covers items from 20100 through 25205, or any items which rely on the Relative Value Guide (RVG), which Gentu does not currently support.
To bill anaesthetic items, it is recommended to print the invoice and mail it to the body in question (Medicare, DVA or the health fund) for processing, or to use the PRODA (Provider Digital Access) online portal.
PRODA (Provider Digital Access) is Medicare's system for transmitting claims. In the event that you need to claim an item which isn't supported by Gentu, PRODA provides an effective alternative.
For more information about the PRODA service, please visit the Department of Human Services website.
Please touch base with our support team if you have any questions regarding billing items. Our team can assist you in determining if items can be claimed through Gentu or if the items will need to be claimed through alternative means.
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