Claims management

Totalclaims is the Totalcare Claims management module. It provides functions to manage Bulk billed, Private and Third party claims. Some of the features of this module are,

  • Integrated Bulk billed claim support for Medicare and DVA. Customisable bulk billed claim support for Worldcare assist, Medibank Private and other insurers.
  • Automatic separation of services into Inpatient or Outpatient claims.
  • Comprehensive validation of bulk billed services prior to submission. This reduces rejections by the Insurer. The validation rules can be customised for different insurers.
  • Bulk billed claims can be sent either manually or electronically.
  • Electronic claim support for the Medicare Online, Worldcare assist, Medibank Private data formats.
  • Automated printing of claim authority declarations for Medicare (DB1) and DVA (D1217) claim forms for manual and optionally electronic submission. Customisable support for Claim authority declarations for other insurers.
  • Automated and manual reconciliation of claims including notification of EFT payments.
  • Automated update of patient Medicare or DVA details upon notification by Medicare or DVA.
  • Manual or electronic resubmission of rejected bulk billed services.
  • Re-request bulk claim processing and/or payment reports for claims submitted via HIC Online.
  • Lodgement of Medicare Online Online deferred Medicare claims.
  • Same day delete of Medicare Online interactive Medicare claims.
  • Automated Medicare Online ECLIPSE support for Inpatient Medical Claims, Overseas Medical Claims, Inpatient Hospital Claims and ECLIPSE Remittance Advices