Medicare and DVA Flags

The 'Flags' button is located to the right of every service that you place on an invoice. This button will only appear on invoices that you will be transmitting to Medicare (bulk bills, patient claims or DVA claims). This allows you to specify extra information that Medicare may require in ordre to rebate your claim.

 

Bulk Billing & Patient Claiming Flags

 

What does each individual flag mean?

  • New Voucher - n/a
  • Accession Date/Time - This is a time stamp value as to when the pathology test was actually performed.
  • After Care Override Indicator - Indicates if service is part of normal aftercare for the patient.
  • Collection Date/Time - The date and time when the pathology specimen for this service was actually collected.
  • Duplication Service Override - Indicates if practitioner attended patient on more than one occasion on same day.
  • Equipment Id - The identification number (allocated by the Dept. of Health & Ageing) of equipment used for the service. Usually applies to radiotherapy equipment.
  • Field Quantity - The number of fields irradiated or the quantity of (15 minutes) time blocks for derived fee intrathecal or epidural infusion service (item 1829 and 18227)
  • Hospital Indicator - Indicates if service rendered in hospital or not. Note: If not set assumed the service was not rendered in hospital.
  • LCC Id - Licensed Collection Centre Identifier. Note: now known as Specimen Collection Point
  • LSP Number - Location Specific Practice Number Only to be used in association with: services listed in the Diagnostic Imaging Service Table (DIST); Group T2 - Radiation Oncology services in the General Medical Services Table (GMST).
  • Multiple Procedure Override Indicator - Free text detailing the reason why the multiple procedure override has been claimed. Note: When set, the associated claim is automatically sent to pend.
  • Number of Patients Seen - The number of patients seen. 1 - 99
  • Rule 3 Exemption Indicator - Indicates if Rule 3 in Medicare Benefits Schedule Book applies or not.
  • S4b3 Exemption Indicator - Flags the associated service as requiring assessing in accordance with S4B3 requirements of the MBS.
  • Self Deemed Code - Indicator is available for the services rendered in the following situations:
  1. Services rendered by a consultation physician or specialist, in the course of that consultant physician or specialist practicing his or her specialty
  2. Service rendered as an additional service to a valid requested service
  3. A substituted service is a service judged to be more appropriate for the diagnosis of the patients condition than the original service requested.
  • Service Text - Free text used to provide additional information to assist with the benefit assessment of the service.
  • Time Duration (mins) - The duration of the service in minutes.

 

DVA Medical Flags - 'General' and 'Specialist' services

 

What does each individual flag mean?

  • Time of Service - The duration of the service in minutes.
  • After Care Override - Indicates if service is part of normal aftercare for the patient.
  • Location Specific Practice Number - Location Specific Practice Number Only to be used in association with: services listed in the Diagnostic Imaging Services Table (DIST); Group T2 - Radiation Oncology services in the General Medical Services Table (GMST).
  • Duplicate Service Override - Indicates if practitioner attended patient on more than one occasion on same day.
  • Multiple Procedure Override - Indicates whether service part of a multiple procedure or not. Note: when set, the associated claim is automatically sent to pend.
  • Number of Patients Seen - The number of patients seen. 1 - 99
  • Self Deemed Code - Indicator is available for the services rendered in the following situations:

1. Services rendered by a consultation physician or specialist, in the course of that consultant physician or specialist practicing his or her specialty
2. Service rendered as an additional service to a valid requested service
3. A substituted service is a service judged to be more appropriate for the diagnosis of the patients condition than the original service requested.

  • Service Text - Free text used to provide additional information to assist with the benefit assessment of the service.

 

DVA Medical Flags - 'Pathology' services

Note: the below definitions are only for flags unique to 'Pathology' services. Flags shared with 'General' or 'Specialist' are covered above.

  • Collection Date and Time - This is the date/time the actual pathology sample was taken/extracted from the patient whether this be blood, tissue or a spontaneous ejection.
  • Accession Date and Time - This is a timestamp value as to when the pathology test was actually performed.
  • Rule 3 Exemption Indicator - Indicates if Rule 3 in Medicare Benefits Schedule Book applies or not.
  • S4b3 Exemption Indicator - Flags the associated service as requiring assessing in accordance with S4B3 requirements of the MBS.
  • Specimen Collection Point - Specimen Collection Point. For pathology services only.

 

DVA Allied Health Flags

 

What does each individual flag mean?

  • Admission Date - The date the patient was admitted to hospital.
  • Time Duration (mins) - The duration of the service in minutes.
  • Discharge Date - The date the patient was discharged from hospital.
  • Duplicate Service Override - Indicates if practitioner attended patient on more than one occasion on same day.
  • Equipment Id - The identification number (allocated by the Dept. of Health & Ageing) of equipment used for the service. Usually applies to radiotherapy equipment.
  • Multiple Procedure Override - Indicates whether service part of a multiple procedure or not. Note: when set, the associated claim is automatically sent to pend.
  • Second Device - This field identifies the provision of a second medical grade footwear service.
  • Self Deemed Code - Indicator is available for the services rendered in the following situations:

1. Services rendered by a consultation physician or specialist, in the course of that consultant physician or specialist practicing his or her specialty
2. Service rendered as an additional service to a valid requested service
3. A substituted service is a service judged to be more appropriate for the diagnosis of the patients condition than the original service requested.

  • Service Text - Free text used to provide additional information to assist with the benefit assessment of the service.

 

DVA Allied Health Flags - 'Dental'

In addition to the above, DVA Allied Health claims with 'Dental' services have the following unique flags:

  • Number of teeth - Identifies the number of teeth for partial denture items. Note: The DVA Dental items that may require a 'Number of Teeth' to be present for claims processing purposes are as follows: D721, D722, D727, D728, S721, S722, S727, S728, T721, T722, T727, and T728
  • Tooth Number - Identifies the tooth number that relates to the dental service provided. Note: The DVA Dental items that may require a ?Tooth number? to be present for claims processing purposes are as follows: D311, D314, D322, D323, D324, D597, S311, S314, S322, S323, S324, S597
  • Upper Lower Jaw Code - Identifies if the dental service relates to the upper or lower jaw. Note: The DVA Dental items that may require either a value of ?UPR? or ?LWR? to be present for claims processing purposes are as follows: D744,D743,S744 and S743

 

DVA Allied Health Flags - Optical'

In addition to the above, DVA Allied Health claims with 'Optical' services have the following unique flags:

  • Optical Script - Identifies the restriction override for optical claims.

Adam Kluga -

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