Claim has been underpaid or overpaid

Underpaid claim

Problem

A claim has been underpaid by the receiving body - Medicare, DVA, or the health fund.

The underpaid item may have an exception.

Usually, the underpayment is an insignificant amount - $0.05. 

Cause

There are many reasons why a claimed item might be underpaid. For instance:

• The item's schedule fee may have changed since you submitted the claim
• You may have charged an excessive gap on a Known Gap claim
• You may not be entitled under your health fund agreement to charge the gazetted fee
• There may be item-specific conditions which have not been met, resulting in underpayment.

Usually, an underpaid item will have an exception which explains the underpayment.

If you are not sure why an item has been underpaid, or you are consistently being underpaid for the same item, please contact the receiving body directly to enquire.

Solution

Underpaid items can be fixed by adjusting the item's fee so it matches what was paid.

You can then mark any exceptions as resolved to finalise the claim.

1. Open the invoice.
2. Click the Adjust icon  corresponding to the item number you wish to adjust.
3. The Adjust Item window will open. 
   
4. Gentu will automatically enter the figure needed to write off the outstanding balance of the item.
   • Alternatively, you can manually key the adjustment amount into the Adjust field.
5. Press Save to apply the adjustment, then Save to close the invoice.

Please see the Adjusting item fees article for more information.

You can then resolve the item by ticking the Mark as resolved checkbox.

Once complete, Save out of the invoice to finalise the claim.

If the item was significantly underpaid, you may wish to dispute this with the receiving body and apply for a top-up amount.

At this time it is not possible to apply for a top-up amount from within Gentu.

Instead, you should print the invoice and mail, email, or fax the account to the body. You should be sure to include any of their required payment top-up forms, if applicable, and/or a cover letter explaining the circumstances of the account.

Overpaid claim

Problem

A claim has been overpaid by the receiving body - Medicare, DVA, or the health fund.

The overpaid item(s) usually will not have an exception against it.

Cause

This can occur if there is a slight fee difference in what was charged vs. the body's current schedule. For instance, this may occur around the time they update their fee schedule.

Otherwise, it may have been a processing error on the body's part.

Solution

To finalise the claim, it is possible to adjust the item fee up so that it matches the payment amount. 

However, we recommend that you notify the receiving body (Medicare/DVA/the health fund) of the overpayment and confirm that you are using the correct fees going forward.

If you receive a significant overpayment, we strongly recommend contacting the body in question to organise a refund of the excess amount.