Medicare Web Services and PRODA

Medicare Web Services

HealthTrack uses the 2022 available webservices interfaces provided by Services Australia. These interfaces are the successor to the Client Adapter technology previously used. Your system will be switched over to using this newer interface as part of the Dolomites 4.4.1 upgrade.

There are minimal user facing changes as part of this upgrade.

  • Patient claims now have a new interaction. If Services Australia indicates that a claim requires further assessment by an operator, the claim is in a ‘PENDABLE’ state. Using the Pendable Submit button will send these through for processing.

  • Online Eligibility Checks are now real-time and will immediately generate a report instead of requiring users to wait for the reports to be downloaded in the background.

  • Service text for item numbers can only contain letters, numbers, and the following symbols: @ # $ % + = : ; , . - . Other symbols will prevent the claim from transmitting electronically.

  • All invoices submitted electronically to Medicare, DVA, and Health Funds will be created in individual batches. You may notice that you have more batches in Accounts > Batch Billing, and each batch will be for a separate invoice, rather than a combination of invoices.

Tip

You can streamline your batching by using the Auto-Batch > Online Invoices button. This method will split the available invoices into appropriate batches and submit them to Medicare.

  • The Claim # in Accounts > Batch Billing will reset daily for each provider number. This means that the first batch on any given day will always be A0001@ or A0001#.

  • Medicare requires that the Primary address for a patient must be residential address. Claims cannot be submitted when the Primary address is a PO Box. You can label addresses in the Other Addresses and Family Members screen.

  • Non-MBS item numbers cannot be submitted electronically to Medicare. This includes items such as MISC. Any non-MBS items will be printed on a separate invoice for the patient.

  • Specialist invoices will require a referral, referral override, or a self-deemed/substituted service indication in order to be submitted electronically.

  • Medicare has introduced additional validation when performing an OPV. In particular, the patient’s date of birth is now verified against Medicare’s system. Please confirm the DOB with the patient, and update in HealthTrack as needed. If you continue to receive verification errors, the patient may need to contact Medicare.

PRODA (Provider Digital Access)

PRODA is an online identity verification and authentication system. This system is used to secure the transactions submitted to Services Australia as part of the webservices interface.

HealthTrack will be managing the authentication via PRODA on behalf of our customer sites. This approach was taken to simplify the administration burden on sites. HealthTrack will manage registrations, renewals of all required B2B devices and other associated tasks.

Your site may still want to setup a PRODA account if they want to interact with some other services. More information is available online:

Services Australia: Issue with DVA Web Services claims for item

Services Australia has been made aware of an issue which a number of practices are experiencing regarding submitting DVA claims for item OT80 using the web services platform.

At present, there are rules applied whereby the VAAW distanceKilometres field is only allowed once per Medical Event. In addition, current functionality does not prevent a chargeAmount from being set where ItemNumber is set to OT80 or KM and the system is not prompting the distanceKilometres to be set where ItemNumber is set to OT80 or KM.

Changes are currently being scheduled to fix this issue, whereby there will be changes made in the way services for item OT80 are currently submitted to Services Australia for processing. Once these changes have been made, we will be updating the relevant TECH SIS guides.

What you need to do

As there is currently an issue with claiming item OT80 via the web services platform, we suggest that practices hold on to claims for these services until a fix is implemented. However, the below claiming options are available if practices wish to claim these services in the interim.

  • If you have an individual PRODA account, lodge a DVA web claim through HPOS.

  • Submit a manual claim for processing.

Should you have any questions about this advice, please contact the Developer Support team at [email protected].

Action required regarding Medicare SHA-1 PKI certificates for subscribers

In regard to the emails received by Medicare titled ‘Action required regarding Medicare SHA-1 PKI certificates for subscribers’.

HealthTrack Online Billing (Medicare Webservices) implementation does not rely on any site certificate/s and is using the recommended PRODA authentication mechanism.

NASH certificates are used in ePrescribing functionality to allow HealthTrack to authenticate on behalf of the doctor/site.

Sites may be using their own SHA-1 Certificate for HPOS access or other services and should follow Medicare’s recommendations to switch over to NASH/PRODA where available.