CSC - Billing and Claiming

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Billing and Claiming

Simplify your billing and claiming processes with CSC Billing solutions. CSC's vast experience across many geographies enables us to deliver localised solutions to meet your Government and health funding requirements.

CSC Billing solutions help you simplify your billing processes. With over 25 years experience in developing hospital and clinic billing solutions, we understand the impact effective billing has on your ability to manage cash flow and optimise your bed utilisation.

The CSC Billing solution’s key features have been developed to integrate with Medicare ECLIPSE (an extension to Medicare Australia's online claiming solutions) to provide online claiming capabilities.

Key Benefits

Fully integrated with our PAS solutions
Real time claim submission
Meets informed financial consent legislative requirements
Claim validation prior to claim submissions
Automatic receipt allocation
Removes the need for paper based claims
Improves business processes
Improves cash flow

Solution Overview

In Hospital Claiming (IHC) allows public and private hospitals and day facilities the ability to submit a claim in relation to the patient's hospital stay. This includes claims for accommodation, transfers, and miscellaneous items such as prosthetics.

Online Eligibility Check (OEC) allows Healthcare Locations the ability to check the eligibility of a patient in relation to their Medicare and Health Fund status and obtain an estimate of out-of-pocket expenses relating to a Hospital stay along with Prosthesis and Miscellaneous services.

The ability of the OEC functionality is to access and collate financial data relevant to the service costs and Medicare and/or RHBO (Registered Health Benefits Organisation) benefits applicable to a proposed episode of care can assist a Provider to provide the patient with sufficient information for the patient to give Informed Financial Consent (IFC).

In-patient Medical Claim (IMC) relates to claims for admitted patient's episodes of care where financial claim(s) are lodged by providers or agents against Medicare Australia, and in most cases a Health Fund, on behalf of a patient for the provision of health care services.

Online Patient Verification (OPV) provides the facility to verify, prior to claim submission, that the:

patient is eligible for claiming Medicare benefits
patient is known to the Health Fund
patient holds a "hospital level" of cover

Enterprise Patient Verification (EPV)

this verification can be requested for up to 1000 patients per transmission
unlike OPV's which receive a synchronous (real-time) response, responses for EPV requests may not be available for up to 72hrs after the submission of the request.

Online Veteran Verification (OVV) provides the functionality to verify, prior to claim submission, that the Veteran patient details match those held by DVA prior to treatment

Patient Verification DVA with personal details only
Patient Verification DVA with DVA File number and personal details

Enterprise Veteran Verification (EVV)

this verification can be requested for up to 1000 patients per transmission
unlike OVV's which receive a synchronous (real-time) response, responses for EVV requests may not be available for up to 72hrs after the submission of the request.

Solution Detail

In Hospital Claiming

Hospital claims can be submitted to any ECLIPSE enabled Health Fund or DVA with a single click
Utilise front end edit checks to improve the quality of your health fund submissions
Fewer Data errors with rejections known immediately
Reduce the time between submission and remittance to improve cash flow
Electronic submission of certificate information

Online Eligibility Check

Real time Health Fund Checks
Meets informed financial consent
Integrated into with the PAS Solutions
No requirement for a third party application
Process eligibility checks up to 12 months in advance or 7 days in arrears (for an emergency admission)
Available 24 x 7
Will check excess, co-payment amounts, waiting periods, BLP’s, pre-existing and financial status
Assists the claims process by ensuring the patient data is correct
Eligibility can be requested by presenting illness or MBS item
Prosthesis gap benefits can be obtained

In-patient Medical Claim

All registered Health Funds are now live with ECLIPSE Medical Claiming
Payment – Can be next payment run depending on the Claim Type and contract agreement with the fund
Medicare Claiming accuracy at 98 %
Medicare Australia and the Department of Veterans’ Affairs improved processes, resulting in less red tape, more automatically paid claims and lower payment times.
Less rejections due to Validation occurring prior to the claim being sent
Faster resolution of claims and faster payment times
Less manual intervention - fewer errors, speedier resolutions
Clearer error messages with a single point of contact for problem resolution
Online patient verification of Medicare enrolment and health fund membership
One system for all health funds
A one stop shop for claiming

Patient and Veteran Verification

Our applications support the requirement to verify a patients Medicare Card No, DVA or Health Fund No.
Fully integrated with the PAS solution

Billing and Claiming

Key Benefits

Solution Overview

Solution Detail

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