Patient Funding Information - Payments, Referrals and Claim Details
The Funding page records how an appointment is paid for and includes funding eligibility information, such as referrals, patient claiming information and patient payment information. Depending on the funding body and the program, fees may be paid wholly by the patient, wholly by the funding body, by a third party, by a combination of patient and funding body or on another basis (e.g. by health outcome or by the number of patients on a practitioner's Patients List). Because this differs for every funding body and every program and every profession, and because it impacts the fee, invoice and clinical reporting requirements, it is incredibly complex and yet incredibly important because it determines whether you (or your patients) are paid or receive rebates.
All you need to do is enter a few details, and Halaxy Classic automatically manages the complex relationship between fees, invoices and clinical reports for you. This way you can ensure that your invoices and clinical reports are compliant with funding bodies' requirements thus helping to ensure that you and your patients are paid as promptly as possible.
- 1 Adding and editing claim details
- 2 Adding and editing referral details
- 3 Adding payment details
- 4 Frequently Asked Questions
- 4.1 How do I change the number of appointments available under a referral? (e.g. appointment limit)
- 4.2 Why is my appointment not showing the referral/ why is the referral displaying as invalid?
- 4.3 I have accidentally created two sets of claiming details on a patient's funding page (e.g. two sets of Medicare or DVA claiming details) - how do I merge the duplicate claiming details?
- 4.4 How do I invoice third parties for patient appointments, reports and assessments?
Adding and editing claim details
Claim information is information that a funding body (i.e. the body that pays or subsidises a service you provide) uses to be able to identify a patient and determine their eligibility and entitlement for services by a particular practitioner, paid for by the funding body. For example, a government healthcare system may identify eligible patients by a number, a claim number or the details of a particular event (such as the date of an accident for accident compensation schemes), or a combination of these. Claim information required differs for each funding body, which Halaxy Classic automatically manages for you based on the fee type you select for a particular appointment.
Before a patient has been booked for an appointment covered by the funding body, you can add their claiming details on their Funding page by clicking the New Claim button. If a patient has been booked for an appointment covered by a particular funding body, you can add or edit a patient's claim information in three ways:
- From an appointment: after you have made an appointment, click the appointment on the calendar and click the Edit icon next to the claim field.
- On an invoice: go to the invoice and click the Edit icon in the Claim and Referral section of the invoice.
- On a patient's profile: go to the Funding page and click the Update Claim Details link next to the claim field in the Claim and Referrals section.
You can also add (but not edit) claim details by clicking the New Claim button at the top right of the Funding page next to the Login toggle.
The actual details that you are required to enter are determined by the funding body for the fee that you have selected for the appointment and invoice. For example, for the example to the right you would enter the information on the patient's Medicare card including the card and individual reference number, as well as the expiry date. For many traffic accident compensation schemes, you enter the patient and claim number and the date of the accident (or determination of injury). Enter the claim details required, and click the Submit button.
Third parties that pay for a patient's treatment (see third party invoices) are also listed on the patient's Funding page.
Merging multiple claims into the one claim details record
When a patient's claiming information has been entered on their Funding page multiple times, you can merge the claiming information listings into the one claim information listing. Duplicate records of the same claiming information can occur when you accidentally add the information multiple times, when you merge patient profiles or when you have a particular funding body entered multiple times on your Funders List.
A Merge icon appears when there are duplicate claiming details listed on a patient's profile. Click the Merge icon next to the claim that you want to merge (the "source claim") into another listing. In the Claim Search field, select the claim (the "destination claim") into which you want the source claim to be merged.
You are then shown a summary of the information to be merged from the source claim into the destination claim listing, including:
- Referrals that have used the source claim information; and
- Invoices/claims that have used the source claim information.
After you have merged the source claim into the destination claim, the referrals and invoice/claims will be linked to the destination claim.
Click the Merge button to confirm that you want to merge the listings. As there is no way to undo merging of claim information, please make sure you do want to merge the claim details into the one listing before you click the Merge button.
Deleting and archiving a claim
You can delete claims that have been added in error (e.g. for the wrong patient, or added as a duplicate) and archive claims that have been used but are not required anymore.
To delete or archive a claim, click the cross icon at the right of the claim information on the patient's Funding page, and then select whether you want to delete the claim or archive the claim - you should delete the claim if there is no appointment or invoice already created that is linked to the claim; you should archive the claim if there is an appointment or invoice already created that is linked to the claim).
Adding and editing referral details
For many professions, referrals from a physician/GP are required for you and your patients to bill particular funding bodies or to access and claim rebates for treatments and services covered by the funding body. Referrals are generally limited by the number of appointments covered under the referral, by the length of time of the referral or by a combination of the two. Referral information appears on a patient's funding page, on invoices for the relevant funding body and on reports.
Once you have added a patient's claim details, you can add referral information in three ways:
- From an appointment: after you have made an appointment, click the appointment on the calendar and click the Add Referral button.
- On an invoice: go to the invoice and click the Add Referral button in the Claim and Referral section of the invoice.
- On a patient's profile: go to the Funding page and click the Add Referral button in the Claim and Referrals section.
If you want to add a referral without entering the patient's claim details, click the New Claim button on the patient's funding page and select the funding body. You do not have to enter any claim details - just click the Next button at the bottom of the popup box. You can then click that you want to add a referral.
Halaxy Classic's referral management process gives complete flexibility to manage all funders' referral requirements while tailoring each referral to the specific requirements of the funder. Add the referral information on the popup box by completing the following steps:
|Referral type||The referral type is dependent on the funding body and your profession, and selecting/adding the correct referral type connects to the type of clinical report required. Type the name of the referral and if you have added it before or the type of referral is listed in Halaxy Classic's database, select it. If the referral is not listed, you can add the referral type so that it is listed on this patient's profile and is also available for your other patients: enter the name of the referral type, the number of appointments it covers (if applicable) and the length of the referral (if applicable) - leave them blank (do not enter 0) if they are not applicable. You can also leave it blank and a Standard referral type is selected.|
|Referrer||Add the name of the referring doctor by starting to type the name of the referrer. If you have already added the referrer for another patient, you can select them from the list that appears. If you have not added the referrer before, add the referrer by entering their name and provider number. The referrer is listed on this patient's profile, added to your Specialists list and available for your other patients.|
|Appointment limit||This is automatically added if relevant for the referral type that you have selected. You can select appointments by days or hours. You can increase or decrease the number of appointments using the up and down arrows. If the referral does not limit the number of appointments, leave this field blank. Halaxy Classic automatically tracks the number of appointments made in Halaxy Classic under the referral for you.|
|Add prior appointments (optional)||If the patient has had appointments under the referral (with you or with another practitioner) before you entered the referral into Halaxy Classic, you can click the Add prior appointments link and type the number of prior appointments into the field. Halaxy Classic tracks the number of appointments made in Halaxy Classic under the referral minus the number of prior appointments entered.|
|Date||Enter the date of the referral.|
|Expiry date||Expiry date is automatically calculated for you based on the referral type and the referral date you entered. If expiry date is not calculated for you, enter the date on which the referral expires. For example, if the referral is for two years, enter the date that is two years after the referral date. If there is no expiry date, leave this blank.|
|Dollar value limit (optional)||You can also set the dollar value limit for treatment costs covered by the referral. For example, if the referral covers $2,000 in treatment costs, enter $2,000 as the dollar value limit (this is relevant for some funding bodies, such as NDIS). You can also set whether the dollar value limit applies to appointment fees only (e.g. if you incurred travel fees, these fees would not be covered by the dollar value limit) or to all fees (i.e. appointments, products, travel and other fees).|
|Recipient||You can choose who the referral is for. By not selecting a specific practitioner, the referral will apply to all practitioners.|
After you have clicked the Submit button, the referral details appear on a patient's funding page, on relevant invoices and on reports.
Adding payment details
Adding a patient's payment details allows you to:
- process their fee payments electronically in one click through Halaxy Classic without the need to handle cash, eftpos or cheque payments; and
- process rebates electronically so that rebates are provided to you and your patients by funding bodies - available with certain funding bodies (e.g. Medicare in Australia).
Adding credit/debit cards
You can add a patient's payment details and enable electronic payments quickly and easily in two ways:
- Via their patient profile: go to the patient's profile, selecting the Funding page and clicking the Add Card button in the Payment Details - Credit Card section. You can store the patient's payment details here to enable electronic processing of future fee payments.
- On their invoice: go to the invoice and in the Payments section, click the Add Payment Details button. You can process the payment immediately and either store the payment details for electronic processing of future fee payments by ticking the tick box (note the CCV is not stored), or not store the card details and continue having future fee payments paid by other means.
In the Name field, add the name on the card - if the patient is a child, a parent's card is permissible. Add the 16-digit card number in the Number field, and select the type of credit card. Visa and MasterCard credit cards are accepted, whereas Diners Club, American Express and transaction/debit cards are not accepted. Add the card expiry date in the expiry fields. If you are adding the payment details from an invoice, you can also enter the CCV number, although this is optional. Read and accept the terms and conditions and click Submit.
Adding deposit account details
Adding patient bank account details ensures Medicare can provide rebates to them overnight. Only savings and transaction accounts can be added because Medicare will not pay rebates into credit cards (though debit accounts are acceptable). To add patient bank deposit account details, go to the Funding page on their profile, and click the Add Account button. Enter the patient's account name and deposit account information (branch code and account number) and click the Save button. The account details are saved to the patient's profile. Whenever you successfully submit a rebate claim to Medicare on behalf of the patient, the rebate will be deposited into this account.
If a claimant is listed, the rebate is paid into the claimant's account and not the patient's.
Setting individual patients' Auto Payments preferences
Just as you can set individual patients' text reminder preferences, you can set individual patients' Auto Payments preferences on their Funding page to override the practice's default Auto Payments preferences. For example, if the overall practice preference is for payments to be processed at 5pm each day but the patient would prefer payments to be processed manually, change the individual patient's preference to Manual on the Funding page of their patient profile.
Frequently Asked Questions
How do I change the number of appointments available under a referral? (e.g. appointment limit)
You can change the number of appointments available under a referral when you add or edit the referral (on the appointment, invoice or the patient's funding page); change the number of appointments available in the Appointments Limit field.
Why is my appointment not showing the referral/ why is the referral displaying as invalid?
There are a number of reasons why the referral may be invalid or not showing. This includes the patient may have exceeded their appointment limit, or the expiry date may have passed, or there is a problem with who the referral has been assigned to. You can change these when you add or edit the referral (on the appointment, invoice or the patient's funding page).
I have accidentally created two sets of claiming details on a patient's funding page (e.g. two sets of Medicare or DVA claiming details) - how do I merge the duplicate claiming details?
You can merge the two sets of claiming details by going to the patient's Funding page and clicking the Merge icon next to the duplicate claiming details and following the prompts.
How do I invoice third parties for patient appointments, reports and assessments?
You create appointments and invoices for third-party funding bodies (such as WorkCover and other compensation schemes) in a similar way to creating patient-direct invoices and Medicare invoices.