A patient claim is when a client pays in full for their appointment with a practitioner and then submits a claim to Medicare and Medicare pays the client the rebate for that appointment. coreplus' PRODA integration allows you to transmit claims on behalf of the client at the time of service. It enables real-time assessment and eliminates the need for your clients to acquire additional information from you to receive their rebate.
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📝 Before you can transmit patient claims through coreplus, you will need to have completed the relevant Setup for Medicare & PRODA

Once you have followed the relevant setup for Medicare Online Claiming, you will need to have completed the below processes to ensure you're ready to transmit the patient claim.

📝 Add the referral for the client
📝 Create an invoice
📝 Apply a full payment to the invoice
📝 Add your service types/item numbers

💡 If the majority of your Medicare claims will be Patient Claims, we recommend that you set your Send request now claiming default to No

💡 This feature is only available on the plus plan

🛑 Once the invoice has been saved as a patient claim, it can't be edited and reverted back to a private claim
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1. Set the type of Medicare Claim to Patient Claim and ensure the Service Category is set to Specialist

2. Set the required Consultation Information such as the Date of Consultation, Location, Referral Information, Time Consulted and Provider Number

​3. Allocate the Service Type to the invoice and tick the Transmit box

​4. Apply a full payment against the invoice by clicking the $ sign

​5. Confirm the referral information has been allocated to the invoice

​6. If required set the Claim Information and then set Send request now to Yes and then click Save Invoice

​7. After submitting the claim, you should then see the assignment advice Client File > Invoicing > Actions > PCI.

A Statement of Claim and Benefit is provided to the claimant when a patient claim has been lodged in real time, processed by Services Australia and a benefit amount returned to the claimant.

A Lodgement Advice is provided to the claimant when a patient claim has been lodged in real time and referred to a Services Australia operator for action.

🛑 Do not leave the Transmit box unticked, the service provided will not be transmitted through to Medicare and you won't be able to submit the claim if you leave it unticked.

💡 IMPORTANT: Submitting a patient claim to Medicare without having a full payment applied can result in Medicare posting a cheque to the patient in the practitioner's name. Be sure to apply full payment before submitting a claim. If you accidentally submit a claim before applying payment use the Same day delete function (only works on same day as claim was submitted) or contact Medicare to cancel the claim.
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💡 IMPORTANT: Due to the transition to PRODA, it's recommended to have the Request Type set to Specialist and Referral Override code set to N/A and Referral Period to 12 months under Referral/Request Information.

💡 If your patient required a referral for this consultation please set the Service Category to Specialist, otherwise you can leave it as General

1. Leave the Medicare claim as No, and fill out the Consultation Info & Service Type, then click Save.

2. Hover over actions for the invoice and select either Manual/Instant Online Payment and process the payment, or click Email to send the payment link.

3. Re-access the invoice, set the Medicare claim as Patient Claim, tick the Transmit box next to the service type, set the Send request now to Yes, then click Update invoice.

4. After submitting the claim, you should then see the assignment advice via Client File > Invoicing > Actions > PCI.

💡 Due to the transition to PRODA, it's recommended to have the Request Type set to Specialist and Referral Override code set to N/A and Referral Period to 12 months under Referral/Request Information.

🚀 You can sync all your invoices for accounting purposes in one place via our Xero add-on. Please, find more about it here: Xero