ANZ Medicare Easyclaim User manual

1– 1
Medicare Easyclaim
Merchant Operating Guide
ANZ POS TURBO™
MEDICARE EASYCLAIM MERCHANT SUPPORT: 1300 633 269
Merchant Trading Name:
Merchant Identication Number:
Terminal Identication Number:
179896_Medicare_Merch_op_Guide_74719.indd 1 6/08/10 5:11 PM

Contents
1. Welcome 4
1.1 Merchant Agreement 4
1.2 Important Contact Details 4
1.3 Important Contact Details for Claimants 4
2. Claim Types 5
2.1 Patient Claims 5
2.2 Bulk Bill Claims 6
2.3 Medical Practitioner 6
3. General Information 7
3.1 Patients and Claimants 7
3.2 Bank Accounts 7
3.3 Optional Fields 7
3.4 Medicare Easyclaim Reference Guide 7
3.5 Express Claims 7
3.6 Receipts 8
3.7 Ineligible Claims 8
3.8 Terminal-Timeout 8
3.9 System Unavailability 9
4. Setting up the Terminal 10
4.1 Adding Terminal Operator IDs 10
4.2 Modifying Terminal Operator IDs 11
4.3 Removing Terminal Operator IDs 12
4.4 Printing an Operator List 12
5. Medicare Admin Functions 13
5.1 Adding Practitioners 13
5.2 Removing Practitioners 14
5.3 Creating MBS Lists 15
5.4 Printing Duplicate Medicare Receipts 16
6. Processing Medicare Claim Transactions - General Practitioners 18
6.1 Paid Patient Claims 18
6.2 Partially paid patient Claims 22
6.3 Unpaid Patient Claims 23
6.4 Bulk Bill Claims 25
179896_Medicare_Merch_op_Guide_74719.indd 2 6/08/10 5:11 PM

7. Processing Medicare Claim Transactions - Specialists 28
7.1 Paid Patient Claims 28
7.2 Partially Paid Patient Claims 32
7.3 Unpaid Patient Claims 34
7.4 Bulk Bill Claims 36
8. Processing Medicare Claim Transactions – Diagnostic Services 39
8.1 Paid Patient Claims 39
8.2 Partially Paid Patient Claims 43
8.3 Unpaid Patient Claims 45
8.4 Bulk Bill Claims 47
9. Processing Medicare Claim Transactions –Pathology Services 51
9.1 Bulk Bill Claims 51
10. Medicare Receipts 54
179896_Medicare_Merch_op_Guide_74719.indd 3 6/08/10 5:11 PM

1. Welcome
We are excited to provide you with Medicare Easyclaim – a service that allows medical
practitioners to process Medicare claims electronically using the EFTPOS network.
This service can benet general practitioners, specialists, diagnostic and pathology clinics
through a reduction in the time and eort spent on completing Medicare claim forms and
through payments usually being made within 24 hours, straight into your nominated bank
account.
Your patients can also benet from this service. Using Medicare Easyclaim they can now
have their Medicare rebate deposited directly into their bank account.
This Merchant Operating Guide provides you with clear and easy-to-follow instructions on
how to process Medicare claims through your ANZ EFTPOS Terminal, including Fully Paid
Patient claims, Unpaid Patient claims, Partially Paid Patient claims and Bulk Bill claims.
This Medicare Easyclaim Merchant Operating Guide should be used in conjunction with
your existing ANZ POS Turbo Merchant Operating Guide. A Medicare Easyclaim online
training guide is also available at anz.com/merchantconnect
Please take time to read this manual thoroughly and ensure that your sta read it too.
1.1 Merchant Agreement
Your ANZ Merchant Agreement contains valuable information and important
requirements relating to operating procedures. Instructions in this Merchant Operating
Guide form part of the ANZ Merchant Agreement and may be varied or replaced by ANZ at
any time.
1.2 Important Contact Details for Practitioners
ANZ’s Medicare Easyclaim Merchant Support 1300 633 269**
(24 hours, 7 days a week)
~ For instructions on how to process Medicare Easyclaim transactions.
~ To report technical problems with the Medicare Easyclaim service
ANZ Merchant Services 1800 039 025 **
(24 hours, 7 days a week)
~ To report terminal faults
Medicare Australia Provider Line 132 150*
(24 hours, 7 days a week)
~ For medical practitioner claiming enquiries
~ For other Medicare Australia system enquiries
1.3 Important Contact Details for Claimants
Medicare Australia Consumer Line 132 011*
(24 hours, 7days a week)
~ For patient or claimant enquiries regarding claim assessment
~ For other general Medicare Australia enquiries.
179896_Medicare_Merch_op_Guide_74719.indd 4 6/08/10 5:11 PM

4– 5
If a claimant has not received their Medicare rebate processed via Medicare Easyclaim,
they should contact the nancial institution that issued the EFTPOS card used in the
transaction.
NOTE: * Call charges apply. 24 hour service.
** Call charges may apply from mobile phones or payphones only.
2. Claim Types
2.1 Patient Claims
There are three types of patient claim:
• Paid;
• Partially Paid; and
• Unpaid
Any Medicare benet payable in respect of a patient claim is payable to the claimant, who
may or may not be the patient.
2.1.1 Paid Patient Claim
A Paid Patient claim is in respect of an account of the medical practitioner that the
claimant has fully paid.
For this patient claim type, where Medicare Australia assesses that a Medicare rebate is
payable, the Medicare rebate will be paid to the claimant.
To process a Paid Patient claim, please refer to:
• Section 6.1 for General Practitioners
• Section 7.1 for Specialists, Allied Health and Dental providers
• Section 8.1 for Diagnostic Services
2.1.2 Partially Paid Patient Claim
A Partially Paid Patient claim exists when a portion of an account of the medical
practitioner has been paid.
Where Medicare Australia assesses that a rebate is payable, Medicare Australia will issue a
statement and a Pay Doctor via Claimant (PDVC) cheque, which is mailed to the claimant’s
address that is recorded with Medicare Australia. Where no benet is assessed as payable,
only a statement will be forwarded to the claimant’s address that is recorded with
Medicare Australia.
The claimant is then responsible for forwarding the cheque, with any outstanding amount,
to the medical practitioner.
To process a Partially Paid Patient claim, please refer to:
• Section 6.2 for General Practitioners
• Section 7.2 for Specialists, Allied Health and Dental providers
• Section 8.2 for Diagnostic Services
179896_Medicare_Merch_op_Guide_74719.indd 5 6/08/10 5:11 PM

2.1.3 Unpaid Patient Claim
An Unpaid Patient claim exists when a claimant has not paid a medical practitioner’s
account.
Where Medicare Australia assesses that a rebate is payable, Medicare Australia will issue a
statement and a Pay Doctor via Claimant (PDVC) cheque, which is mailed to the claimant’s
Medicare address that is recorded with Medicare Australia. Where no benet is assessed as
payable, only a statement will be forwarded to the claimant’s address that is recorded with
Medicare Australia.
The claimant is then responsible for forwarding the cheque, with any outstanding amount,
to the medical practitioner.
To process an Unpaid Patient claim, please refer to:
• Section 6.3 for General Practitioners
• Section 7.3 for Specialists, Allied Health and Dental providers
• Section 8.3 for Diagnostic Services
2.2 Bulk Bill Claims
A Bulk Bill Claim is a claim made by a medical practitioner who undertakes to accept the
relevant Medicare rebate(s) as full payment for the service(s) provided by that medical
practitioner to the patient and where the right to that Medicare rebate(s) has been
assigned to the medical practitioner by the patient.
It is the medical practitioner’s discretion whether to bulk bill a Patient or not.
To process a Bulk Bill Claim, please refer to:
• Section 6.4 for General Practitioners
• Section 7.4 for Specialists, Allied Health and Dental providers
• Section 8.4 for Diagnostic Services
• Section 9.1 for Pathology Services
2.3 Medical Practitioner
For all patient claim types, the medical practitioner can be a General Practitioner,
Specialist, Allied Health Provider, Dentist, Radiologist or any other practitioner who
provides a medical service, which is covered by the Medicare Benets Schedule.
For all Bulk Bill claims, the medical practitioner can be a General Practitioner, Specialist,
Allied Health Provider, Dentist, Pathologist, Radiologist or any other practitioner who
provides a medical service, which is covered by the Medicare
Benets Schedule.
179896_Medicare_Merch_op_Guide_74719.indd 6 6/08/10 5:11 PM

6– 7
3. General Information
3.1 Patients and Claimants
Medicare Easyclaim makes references to both patients and claimants. The patient is the
recipient of a medical service. The claimant is the person receiving the Medicare rebate
relating to the service provided.
The patient and claimant may be the same person or dierent people e.g. a child receiving
the service is the patient and the child’s parent or guardian may be the claimant. Multiple
patients can be listed on a single Medicare card, but each patient claim must be processed
individually.
3.2 Bank Accounts
Medicare rebates can only be paid into a cheque or savings account, not into a credit card
account. However credit cards can be used to pay for the service provided in accordance
with your usual business processes.
3.3 Optional Fields
In certain circumstances, you may be asked to enter additional information to allow
Medicare Australia to assess the service and process the claim. Omission of this
information may result in either a rejection or Medicare Australia contacting you for
clarication.
Examples of optional elds include, Item Override Code, Equipment Identication Number,
Self Deemed Code, Account Reference Number and Location Specic Practice Number
(LSPN).
Please refer to your Medicare Easyclaim Reference Guide to view denitions of the above
optional elds. The Medicare Easyclaim Reference Guide is included in the Medicare
Easyclaim Starter Kit and is available directly from Medicare Australia.
3.4 Medicare Easyclaim Reference Guide
For more information about Medicare Easyclaim, including services that are not supported
by Medicare Easyclaim, please refer to the Medicare Easyclaim Reference Guide, or visit
www.medicareaustralia.gov.au and click on the link for Health Professionals.
3.5 Express Claims
The Medicare Easyclaim application has an Express Claim option for Paid Patient claims and
Bulk Bill claims.
Depending on the type of medical practitioner processing the claim, the following steps
may not be presented:
• Payee Provider
• Item Override Code
• Location Specic Practice Number
• Equipment ID
179896_Medicare_Merch_op_Guide_74719.indd 7 6/08/10 5:11 PM

3.6 Receipts
The terminal will produce a Medicare receipt for each claim (including cancelled claims),
please hand this receipt to the claimant. For cancelled claims, also provide a medical
account receipt to enable the claimant to make a claim through an alternative channel.
For Bulk Bill claims, a two-part receipt will be printed. Please hand the completed receipt
to the patient.
The terminal can print a duplicate of the EFTPOS receipt from the last transaction. This
would be used in circumstances where the terminal runs out of paper mid-receipt. If the
medical practice requires copies of all Medicare receipts refer to Section 5.4 to enable
duplicate receipt printing.
Sample receipts are contained in Section 10 of this guide.
3.7 Ineligible Claims and Error Codes
Where a claim is lodged for a patient who is not eligible for Medicare benets or service,
Medicare Australia will reject the claim and a brief message, including an error code, will
be displayed on the terminal indicating that the Patient is not eligible. Please refer to the
Medicare Easyclaim Reference Guide for error code denitions.
A receipt is printed showing the 4 digit error code e.g. 9611.
3.8 Terminal Time-out
There are a number of scenarios where the Medicare Easyclaim application can time-out.
Scenario 1 - Patient Claim
If the Medicare Easyclaim operator pauses for more than approximately 30 seconds during
the entry of patient claim details at any point prior to Medicare Australia approval, the
terminal will time-out.
When a time-out occurs in this scenario, the terminal will return to the ANZ Idle screen and
the claim details will need to be entered again.
Scenario 2 - Patient Claim
If there is a delay of approximately 30 seconds between the claimant swiping their EFTPOS
card and entering their PIN, a time-out will occur.
When a time-out occurs in this scenario, a message will prompt the claimant to retry their
PIN entry. If the claimant does not enter a PIN, the transaction will be cancelled and a
‘Cancelled by Practitioner Receipt’ will be produced.
Scenario 3 - Bulk Bill
If the Medicare Easyclaim operator pauses for more than approximately 30 seconds during
the entry of patient claim details at any point prior to the Assign benets screen, the
terminal will time-out.
When a time-out occurs in this scenario, the terminal will return to the ANZ Idle screen and
the claim details will need to be entered again.
179896_Medicare_Merch_op_Guide_74719.indd 8 6/08/10 5:11 PM

8– 9
Scenario 4 - Bulk Bill
If there is no response within approximately 30 seconds to the prompt on the Assign
benets screen, the terminal will time-out.
When a time-out occurs in this scenario, the transaction will be cancelled and a ‘Cancelled
by Practitioner Receipt’ will be produced.
3.9 System Unavailability
Should the Medicare network become unavailable for a period of time, the terminal will
display a message when you attempt to next process a claim.
In this event, you may advise the claimant to lodge their claim through an alternative
channel.
179896_Medicare_Merch_op_Guide_74719.indd 9 6/08/10 5:11 PM

4. Setting up the Terminal
4.1 Adding Terminal Operator IDs.
A user ID is required to process Medicare transactions. The user ID is part of the Security
mode features of the ANZ EFTPOS terminal. Security mode is used to prevent unauthorised
use of the terminal when it is left unattended.
01/01/2010 12:08
From the ANZ start screen, keep pressing ENTER
until the ‘SERVICES’ screen is displayed.
SERVICES
XTRA
Select XTRA from the menu by pressing the CHQ
soft-function key.
SERVICES
1 MEDICARE EASYCLAIM
9 ADMIN
From the SERVICES menu, press the FUNC
button.
SERVICES
1 END SESSION
2 BARCODE PRINTING
3 TERMINAL UPDATES
4 MERCHANT SETTINGS
Press 4 to select MERCHANT SETTINGS.
SYSTEM ADMIN
Master User Id?
Enter Master User Id (default Id is 467263) then
press ENTER.
MERCHANT SETTINGS
1 OPERATOR ADMIN
2 SECURITY MODE
3 TIMERS
4 REVERSAL
Press 1 to select OPERATOR ADMIN.
OPERATOR ADMIN
1 ADD OPERATOR
2 MODIFY OPERATOR
3 REMOVE OPERATOR
4 OPERATOR LIST
Press 1 to select ADD OPERATOR.
SWIPE OR
INSERT
CARD
179896_Medicare_Merch_op_Guide_74719.indd 10 6/08/10 5:11 PM