Submitting Medicare Patient Claim Webclaims using HPOS

A guide to help health professionals submit Medicare patient claims electronically for real time assessment through HPOS.

Medicare Patient Claim Webclaim is an online claiming channel through HPOS where you submit Medicare claims on behalf of your patients at the point of service. This provides real time assessment and reduces the need for your patients to get additional information from you to get their Medicare benefit. For example, as part of submitting the claim you can let us know a service was not aftercare.

To complete your claims using HPOS you must:

  • have access to the internet and a printer - you don’t need specific software
  • be a registered HPOS user

Registering for HPOS ensures the information you submit through our online services is secure. You must have a Provider Digital Access (PRODA) account to submit Medicare Patient Claim Webclaims using HPOS. There may be limited situations where PRODA is not an option, please contact the eBusiness Service Centre for assistance.

What you can claim

All Medicare eligible items rendered in-hospital and out-of-hospital can be claimed using a Medicare Patient Claim Webclaim including:

  • general medical services
  • dental services
  • optometric services
  • specialist services
  • Allied Health services
  • Diagnostic Imaging services
  • pathology services

Submitting a Medicare Patient Claim Webclaim

Once you’ve lodged your claim, you’ll get an immediate response. Submitted claims will return a status of either ‘Paid’ or ‘Requires Further Assessment’.

Medicare Patient Claim Webclaim saves the last service type you entered to help you lodge your claims. You can also begin claims and finalise them later.

Notional charges can’t be entered in a Medicare Patient Claim Webclaim. You must enter the benefit amount against each service.

Submitting a claim

  • Select Claims
  • Select Make a new claim
  • Select Medicare Patient Claim Webclaim
  • Select Find a patient and enter your patient’s details
  • Select Find
  • Select the patient and then select Next
  • Enter claimant details, select Find
  • Select the claimant, select Next
  • Enter claim details, select Next
  • Select Assess Claim to send the claim for initial assessment
  • Review Claim Summary
  • Acknowledge the provider declaration and read the privacy note
  • Select Submit Claim
  • Print Statement of Claim and provide a copy to the claimant

Medicare Patient Claim Webclaim lets you to submit 1 claim per patient to a maximum of 14 item numbers in a claim.

  • All item numbers in a claim can be for a different date of service and service type. Services with different dates of service must be claimed under separate medical events
  • All items in a claim must be for the same account status (i.e. either paid or unpaid) and same service location type (i.e. either in-hospital or out-of-hospital)

If you’ve made an error in a submitted claim, you can’t delete the claim in HPOS. You need to the Medicare provider enquiries to delete the claim. The request to delete a claim only applies to claims submitted on the same day.

Once you’ve entered patient details, you can save a claim at any stage in the process.

Finalising a claim after saving

Saved claims that haven’t been finalised will be deleted after 30 days. Where edits are saved, the 30 days period begins again.

  • Select Claims
  • Select View saved claims
  • Select Medicare Patient Claim Webclaim
  • Select relevant saved claim
  • Click ‘Open claim’
  • Enter missing claim details
  • Select Assess Claim to send the claim for initial assessment
  • Review Claim Summary
  • Acknowledge the provider declaration and read the privacy note
  • Select Submit Claim
  • Print Statement of Claim and provide a copy to the claimant

Specialist claims

Any procedure contained in MBS Category 3 must be claimed separately. For example, if there’s more than one anaesthetic service performed on the same date of service, a separate claim form must be completed for each anaesthetic service group.

The Number of patients’ seen/field quantity field is used to advise the number of units required for nerve block services.

Claims referred to us for further assessment

For services that need more information for assessment, you’ll get a return message telling you which field this relates to. Where necessary, additional fields will become available. As long as all other details in the claim are correct, Medicare Patient Claim Webclaim lets you submit a claim with additional information for further assessment.

Claims sent for further assessment will generally be processed within 2 business days.

Accessing processing reports

A processing report is available 1 business day after your claim has been finalised. You don’t need to subscribe to get these reports - they will be sent to you through Messages.

Processing and payment time

When a Medicare Patient Webclaim is submitted successfully and doesn’t require further assessment, it is processed immediately. Claims submitted using Medicare Patient Claim Webclaim that require additional assessment are usually processed within 2 business days.

Payments to claimants that have valid bank account details recorded with us will get their Medicare benefit the business day after the claim is finalised.

If a claimant hasn’t registered their valid bank account details with us, you’ll get a message asking if the claimant would like to provide their banking details for processing of the claim through Medicare Patient Claim Webclaim. For privacy and security reasons banking information supplied as part of a Medicare Patient Claim Webclaim can’t be used to update a Medicare record. Claimants should be told to contact Medicare on 132 011 to update their personal details.

For unpaid claims, a Pay Doctor via Claimant cheque is issued in the next available payment run after the claim is finalised.

Service availability

Medicare Patient Claim Webclaim is not available for claim submission between 11:30 pm and 12:30 am. You can still enter in the service details during this time and save them for submission at a later time.

Page last updated: 24 August 2016

This information was printed Friday 9 December 2016 from humanservices.gov.au/health-professionals/enablers/submitting-medicare-patient-claim-webclaims-using-hpos It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.