In this article:
Gentu can send electronic claims to Medicare, DVA, and participating private health insurance funds. We've automated as much of the claiming process as possible to cut down on turnaround times and reduce the possibility of clerical errors.
Gentu can retrieve any processing and payment reports unsupervised and will even automatically receipts claims, freeing up your time for other tasks.
Before using online claiming, you must register your details with Medicare and with each private health fund. Click here to visit the Human Services Australia website for more information.
Here is a simplified explanation of claiming in Gentu.
Claims Control is the screen where Gentu collates and displays all of your previously submitted claims. You can access Claims Control via the Financials panel (Financials > Claims Control).
Claim ID & Provider: These two self-explanatory columns list the Claim ID and the sending provider's name respectively.
Claim Types: The Claim Types column shows the claim's type - for example, Bulk Bill: Outpatient or DVA: Inpatient. If the claim is a private health fund claim, the Claim Type column will list the name of the health fund instead (e.g. BUPA Australia).
Sent: The Sent column shows the date on which the claim was originally sent. If the claim did not send successfully, the Sent column will instead display an Error icon.
Reported: After a claim has been sent successfully and is awaiting is processing report, it will display a triple dot icon in the Reported column. When a claim's report is available, the Reported column will list the date on which the report was retrieved (as per below).
Clicking on the date link within the Reported column will open the Processing Report window (below) showing details of the claim. The processing report window can look different, depending on the type of claim it is for.
You can click the Re-retrieve button to re-retrieve the report file from Medicare's servers.
If Gentu was not able to retrieve a report for the claim, it will display the Error icon within the Reported column instead. This usually means that Gentu has waited for an electronic report for the claim, but the report has not been made available or is not able to be received.
Please see our Sending Errors article for more information on resolving sending errors.
If there are Exceptions present for this claim, you will see the Exceptions notification within the Reported column. For more information on Exceptions, please see our Resolving, Reclaiming & Manually Receipting article.
Finally, if the Reported column displays "Claim Resent on: [00/00/00]", it means that this claim (or some of its items) have been resubmitted in a later claim.
Payment Reference: This column will list the Auto Receipt notification once the claim has been auto-receipted, alongside the claim's unique payment reference ID. (This ID should reflect the payment reference shown in your actual bank account statement.) Clicking on the payment reference link will launch the Payment Summary window.
(Example of the Payment Summary window, from our demonstration database.)
Occasionally, the Payment Reference column may display a Receipting Required notification . Please see the Resolving, Reclaiming & Manually Receipting article for more information.
Like the Processing Report window, the Payment Summary window will show slightly different details depending on the claim type (Medicare/DVA/health fund).
The Claim Status checkboxes at the top of the Claims Control screen let you choose which claims to display (those with exceptions, those still in progress, those which are finalised, or any combination thereof). Simply check and uncheck the relevant boxes as needed.
The Filter button lets you further narrow down the claims displayed. By clicking this button you can select claims belonging to a certain provider, and/or those within a certain date range.
- As you bill patients throughout the day, Gentu keeps your bulk bill accounts (including DVA accounts) in a holding queue.
- At 10pm each night, Gentu batches all the accounts and then automatically sends them off to Medicare.
- The Claims Control screen will tell you how many invoices are awaiting automatic batch claiming.
- If there are any Bulk Bill or DVA-type invoices waiting to be transmitted, you will see a banner at the top of the Claims Control tab similar to that shown above, letting you know how many invoices are pending transmission.
Note that Gentu will always transmit these pending claims at 10pm daily. This is a default setting and is not able to be changed.
See also: Invoicing Bulk Bill & DVA
When Medicare/the Fund deem the claim as payable:
- Medicare/the Fund generate and send an electronic Payment Report back to you.
- Gentu receives the Payment Report into Claims Control.
- Medicare/the Fund deposit the benefit payable into the doctor's nominated bank account.
- Gentu automatically receipts the payment based on the information in the Payment Report.
- The receipt is shown in Financials > Banking Report.
When Medicare/the Fund pays the benefit for a claim, the money will be deposited directly into the doctor's nominated bank account.
Medicare/the fund will simultaneously provide a Payment Report (also known as an Electronic Remittance Advice). The Payment Report is effectively a statement of payment advising what you have been paid for each claim.
After you have received the Payment Report, Gentu will automatically process a receipt using the figures provided.
Gentu will only receipt up to the benefit amount stated in the processing report. Therefore, even if a claim has been auto-receipted, it may still be necessary to adjust the item if there are exceptions/underpayments in the processing report.
Please note: The payment report is returned directly from Medicare. Gentu does not have any influence over the contents of the payment report or how Medicare/the Fund chooses to pay for a claim. If you are concerned about the contents of the payment report, please contact the relevant party directly (DVA, Medicare, or the private health fund).