Medicare Easyclaim

Bulk bill claim definitions

Bulk bill claim definitions for Medicare Easyclaim.

Bulk bill claims

A bulk bill claim is where a patient who is eligible for a Medicare benefit assigns their right to the benefit to the servicing provider as full payment for that service and the health professional lodges the claim with us.

It is at the health professional’s discretion whether or not to bulk bill a patient.

Accept or decline indicator

Where a Medicare eligibility or concession entitlement is returned by us, the medical practice or patient may choose to accept or decline the claim.

Assignment of benefit

When a patient assigns their right to the benefit to the servicing provider as full payment for those services.

Benefit assigned amount

For Medicare Easyclaim, the benefit returned in a bulk bill claim refers to an estimate of the benefit that the health professional will be paid.

This amount may be adjusted in accordance with the rules set out in the MBS.

Claims per transaction

Only 1 bulk bill claim can be submitted per transmission. This claim may contain more than one service item.

Real time Concession Entitlement Verification (CEV)

When the bulk bill claim is lodged, we will validate the patient’s concession entitlement only if the patient’s Medicare card is valid.

Retention of records

We recommend practices keep all records associated with benefits paid for at least 2 years. These records can include electronic billing information, notes in practice software, appointment records and assignment of benefit forms. In the event of an audit, this information will help health professionals to validate to us that claims have been correctly paid.

Transmission of bulk bill claims

Bulk bill claims are transmitted to us in real time but are not assessed immediately.

Basic patient or provider eligibility checks occur before the patient and provider accept or decline the assignment of benefit. The patient must be present to press OK to assign their benefit.

The receipt that is printed is an Assignment of Benefit Advice only and indicates that the claim has been successfully transmitted to us.

The practice must give the patient a copy of the receipt.

This information was printed Friday 24 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/medicare-easyclaim/resources/bulk-bill-claim-definitions It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 22 February 2019