ANZ HealthPay Medicare Claiming Merchant Operating Guide
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2. Claim Types
2.1 PATIENT CLAIMS
There are three types of patient claim:
•
Paid
•
Partially Paid
•
Unpaid.
Any Medicare benefit 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 where a claimant has fully
paid the Medical Practitioner.
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.
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
benefit 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.
2.1.3 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 benefit 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.
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.
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 Benefits 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 Benefits Schedule.