Medicare Easyclaim for health professionals

Medicare Easyclaim lets you lodge Medicare claims using your EFTPOS terminal. Payments are usually made within 24 hours, straight into your nominated bank account.

You can also offer Medicare Easyclaim to your patients. Patients use it to claim their Medicare rebate once their account is settled, and have their Medicare rebate paid into their bank account almost immediately. Our research shows that more than 80 per cent of patients who pay their doctor expect electronic Medicare claiming to be available within the next 12 months.

Find out more about what Medicare Easyclaim means for patients.

To talk to a Medicare Australia staff or arrange for a Business Development Officer to visit your practice, call the eBusiness Service Centre on 1800 700 199.  

Key features

• Can be used for patient and bulk bill claims
• No batching or storage required for bulk bill claims
• Single payment within 24 hours, direct into your nominated account
• More certainty with ‘pay doctor’ cheques - speeds up process by lodging claim on-the-spot
• No additional bank transaction fees - though standard EFTPOS charges still apply
• Concession verification - instant confirmation of patients’ concessional status
• Available to doctors, specialists and allied health professionals (including dentists and dental specialists).

Support for practices

Contact the eBusiness Service Centre:

• for Medicare Easyclaim information and enquiries
• to change contact and practice details
• to register and update banking details for providers
• for information about the processing of data received by Medicare Australia
• to organise an on-site visit by a Business Development Officer.

For further support:

• Electronic Claiming factsheet [PDF, 302Kb]
• Order a copy of the Medicare Easyclaim Starter Kit
• View the Reference Guide
• View the Processing and payment reports
• List of return codes [PDF, 150Kb]
• List of return codes [RTF, 835Kb]
• Medicare Easyclaim – banking details for bulk bill claims form [PDF, 209Kb]
• Call the eBusiness Service Centre on 1800 700 199

For technical problems with transmissions call the bank or financial institution which supplies the service.

How it works

How it works for bulk bill claims:

What’s different - faster payment and less paperwork (no batching)

1. The patient’s Medicare card is swiped through the practice’s EFTPOS terminal or details stored in the integrated practice management software.
2. Claim details are entered via the keypad or use the details stored in the integrated practice management software. Short-cut keys can be used for provider and common item numbers.
3. The claim is sent to Medicare Australia for verification and an approval message is sent back to the terminal within seconds. 
4. The patient then presses a button on the keypad to assign their Medicare benefit to the doctor. The terminal prints a patient receipt.
5. The health care provider receives a single payment in their nominated bank account within 24 - 48 hours.  No more batching or storing claims

 How it works for paid patient claims:

What’s different - another value-added service to offer patients

1. The patient/claimant pays as usual (eg. cash, cheque, credit card or EFTPOS) and their Medicare card is either entered or swiped through the practice’s EFTPOS terminal.
2. Basic details are entered via the EFTPOS keypad or entered using the integrated practice management software. Short-cut keys can be used for provider and common item numbers.
3. The claim is sent to Medicare Australia for verification and a successfully transmitted response message is sent back to the terminal within seconds.
4. The patient swipes their EFTPOS card through the EFTPOS terminal and enters their PIN. If Medicare accepts the service the Medicare rebate is paid directly into their cheque or savings account almost immediately.

 How it works for unpaid and part paid accounts

What’s different - more certainty that ‘pay doctor’ claims are lodged

1. The patient’s Medicare card is swiped through the practice’s EFTPOS terminal or details stored in the integrated practice management software.
2. Claim details are entered via the keypad or use the details stored in the integrated practice management software. Short-cut keys can be used for provider and common item numbers
3. The claim is sent to Medicare Australia for verification and an approval message is sent back to the terminal within seconds.
4. If Medicare Australia accepts the service, a ’pay doctor’ cheque will be sent to the patient, who brings it to the practice along with any outstanding balance.

Frequently asked questions

Which financial institutions have signed on to deliver Medicare Easyclaim?

Currently, the following financial institutions that have signed on to deliver this service are:

• Commonwealth Bank of Australia
• National Australia Bank
• Tyro Payments
• ANZ
• Suncorp Bank
• HICAPS

Are there any fees associated with using Medicare Easyclaim?

There are no additional bank transaction fees for either patients or practices using Medicare Easyclaim. However, standard EFTPOS charges will still apply, including the cost of renting a terminal. Talk to your EFTPOS provider to find out more.

See also: Which financial institutions have signed on to deliver Medicare Easyclaim

What equipment is needed for Medicare Easyclaim?

Medicare Easyclaim uses the EFTPOS terminal already in most surgeries. As a result, practice staff will only need minimal training in how to use this claiming channel.

Some practices have asked if they will need a second EFTPOS terminal - this is a matter for the practice and depends on how the practice runs and which claiming solutions are in place.

If you don’t already have an EFTPOS terminal, talk to your financial institution. (See also: Which financial institutions have signed on to deliver Medicare Easyclaim)

Will traditional patient claiming methods still be available?

Yes - patients will still be able to claim through the current claiming options. This includes the 238 Medicare offices around Australia, which will all remain open. Medicare Easyclaim gives both patients and practices more choice.

Do I need to choose between Medicare Easyclaim and Medicare Online (HIC Online)?

Medicare Easyclaim is simply another claiming channel for practices to choose from. If you currently use Medicare Online you might decide to continue using it to lodge some types of claims and to use Medicare Easyclaim for other types. It depends which works best for you and your practice. Currently around 7,100 practices use Medicare Online and around 2,097 of these use it for patient claims - you can choose to use Medicare Online for patient claiming instead of Medicare Easyclaim if this suits you better.

For patient claiming, Medicare Easyclaim involves swiping the patient’s Medicare card and EFTPOS cards to enable payment of the Medicare rebate to their bank account almost immediately.

For bulk billing it involves swiping the patient's Medicare card - payment is made to the practitioner usually within 2 - 3 days.

Compare claiming methods

 Is there anything I can’t claim through Medicare Easyclaim?

There are some medical services that can’t be claimed using Medicare Easyclaim, including services for veterans (DVA claims), childhood immunisation (ACIR information), in-hospital services and complex pathology. These services can be claimed using other claiming channels, including Medicare Online.

 I’m an allied health practitioner/dentist/dental specialist. What does this mean for me?

Allied health professionals, dentists and dental specialists are able to use Medicare Easyclaim and Medicare Online to submit bulk bill and patient claims.

Allied health professionals are:

Find out more about the allied health initiative.

 Will I need to change my computer software?

Medicare Easyclaim can be used as a stand-alone system, so you don’t have to change your computer software to run it.

 Will I have to collect patients’ bank account details?

No - a paying patient simply swipes their Medicare and EFTPOS cards through your EFTPOS terminal, and the information is automatically transmitted.

 Will patients’ privacy be protected?

Yes - patient privacy is protected. All information sent via EFTPOS is encrypted and sent through a secure network. As part of the accreditation agreement for Medicare Easyclaim, financial institutions are not permitted to collect or store or use any health claiming information.

 What happens if a claim is rejected?

Patient claims lodged through Medicare Easyclaim are assessed instantly so if a claim is rejected, the EFTPOS terminal displays a four-digit error code that explains why the claim was rejected. Patients can then take their account invoice or receipt to their local Medicare office, or use any of the other claiming options available.

 I’ve read transactions can take up to four minutes. Is this true?

It’s hard to give an exact time estimate because of the number of different factors involved, including the type of claim and how comfortable the patient or practice manager is with EFTPOS. Based on our trials, we expect most transactions will be processed in one or two minutes using a stand-alone solution, and less using an integrated solution.

 How do I reconcile payments?

Medicare Australia encourages practices to choose the claiming option, or combination of options, that best suit their business requirements. One consideration for practices in making this choice is how they do, or would like to, reconcile their bulk bill claims.

For Medicare Easyclaim, operating as a stand-alone solution, medical practices obtain their bulk bill processing and payment reports by accessing the Health Professional Online Services, via the Medicare Australia website. They then download and print a PDF or excel file and reconcile this report against their claims. Due to the information contained in these reports, their size and the need to print the reports, it is not possible to retrieve these via the EFTPOS terminal.

For Medicare Online, which is integrated into Practice Management Software (PMS), practices obtain their bulk bill processing and payment reports by submitting an electronic request to Medicare Australia. The reports are sent by Medicare Australia in real-time and the PMS will, generally, automatically reconcile your bulk bill claims.

There is no requirement for medical practices to reconcile patient claims in either Medicare Online or Medicare Easyclaim. Medical practices could therefore choose to use Medicare Online for their bulk bill claims, for automatic reconciliation, and Medicare Easyclaim for their patient claims, for real-time payment of patient benefits.

 Is automatic reconciliation available with Medicare Easyclaim?

Automatic reconciliation is available for financial institutions to integrate with Medicare Easyclaim solution into their practice management software.

 If it’s not integrated with my software, will there be more keying errors?

For some practices there is a chance of data entry errors because of the need to double key some claim data - first on the EFTPOS terminal, then on practice management software. However, Medicare Easyclaim-enabled EFTPOS terminals will have some claim data hard-coded in, such as provider numbers and common item numbers, which will speed-up transactions and reduce the chance of errors.

Swiping Medicare and EFTPOS cards through the EFTPOS terminal instead of keying these numbers will also save time and reduce error rates.

Medicare Easyclaim is a claiming channel that works best for simple claims, such as those with one item number, where less data is involved.

Note: About 70% of all Medicare claims have just one item on them.

 How do I ‘switch on’ Medicare Easyclaim at my practice?

Medicare Easyclaim is now gradually rolling out as participating EFTPOS providers become accredited and start to offer the system to practices. (See also: ‘Which financial institutions have signed on to deliver Medicare Easyclaim’)

If you already have an EFTPOS terminal, contact your financial institution to ask if they will be offering Medicare Easyclaim.

If you don’t have an EFTPOS terminal, contact your financial institution to ask if they will be offering Medicare Easyclaim, and to see about having a terminal installed (standard EFTPOS fees apply).

 How is Medicare Australia supporting the system?

For practices

• Medicare Australia is working with peak medical bodies in each State and Territory to help explain the choice offered by Medicare Easyclaim.
• Medicare Australia’s business development officers are contacting practices to offer one-on-one presentations about the system.
• Participating financial institutions will offer training materials and technical support.
• Practices that choose to offer Medicare Easyclaim will receive a starter kit with support materials including user guides, waiting-room posters and brochures.

For patients

• A public communication campaign ran in May and June 2009.
• Information brochures are available from participating doctors and Medicare offices

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Last updated: 23 November, 2012

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