Your Guide to Medicare and DVA Payment Reports (AU-only)

Zanda's integration with Medicare and the Department of Veterans' Affairs (DVA)
streamlines the entire claiming and payment process for your practice. Instead of manually submitting and tracking claims via your PRODA account, this integration allows you to manage everything directly within your Zanda account. We provide this integration to simplify your administrative tasks, speed up payments, and provide a clear, digital record of every claim.

The Medicare and DVA Payment Status Report is a critical part of this integration. It's the final piece of the puzzle that closes the loop on each Bulk Bill and DVA claim, giving you a detailed breakdown of its journey from submission to payment.

This report is not just a summary; it’s a powerful tool that helps you understand payment outcomes, identify and resolve issues, and ensure your billing is accurate and efficient.

In this article: 

• Understanding Why Reports Are Important
• How to Access Your Reports
  
  • Accessing Reports For a Single Claim
    
  • Accessing Reports For Multiple Claims (Batch Processing)
• Recording Payments Two Ways
  
  • Option 1: Automatically Allocate Payments
  • Option 2: Manually Record Payments on Single Invoices
• Navigating Explanation Codes
• Common Troubleshooting

Understanding Why Reports Are Important

Think of a Payment Status Report as a detailed receipt from Medicare and the Department of Veterans' Affairs (DVA). It fetches Medicare's feedback to you to explain exactly what happened—if the Bulk Bill or DVA claim was paid, how much was paid, or if there was a problem that needs your attention. Knowing how to read these reports is essential for making sure your practice gets paid correctly and on time.

This guide will walk you through how to request, access, and interpret these reports for Medicare Bulk Bill and DVA claims, so you can easily understand what Medicare is telling you.

How to Access Your Reports

Accessing Reports For a Single Claim

1. From the Tools > Medicare Dashboard, find the claim you want to check. Alternatively, you can access claim information for a single invoice from its Edit page

   

2. Click on the claim ID link to view the details.
   
   

3. If the report isn't there, click the "Request Report" button. This will send the request to Medicare and it will return with the processing and the payment reports for this claim. 

4. Once the payment status report request is sent from a Zanda account, Medicare Service Response will be received and its status will be populated on the claim's page: 

   1. Report Not Available: This status can mean a few things:

      • The report hasn't been requested yet.

      • It has been requested, but Medicare is still processing it.

      • The claim has been processed, but the payment hasn't been made yet.

   2. Report Available: This is what you want to see in Medicare Service Response! It means the report is ready to be viewed. A few key codes indicate a successful or pending outcome:

      • Code 0: The claim was processed successfully.

      • Code 9501: The claim has been referred for review by a Medicare officer.

      • Code 9783: The report is available, but the system indicates bank details are missing for the claim, which is an acceptable error.

5. For further details, click the "Processing Report" or "Payment Report" button.
   
   

   • Processing Reports: These are your "audits." They give you the full story on how Medicare processed each line item of your claim. This is where you'll find any error codes or detailed explanations about why a claim was rejected or paid differently than expected.
     
     

   • Payment Reports: These reports are your "bank statements." They provide a summary of all the payments made to your practice, including the total amount, the bank account the money was sent to, and which payment run the funds were part of.

     • Even if you are reviewing the payment report for a specific claim, you will see the 'Claim Payment Data' list of other claims which were paid by Medicare in your bank account withing the same payment run
       
       

   ☑️ Both report types are available for Bulk Bill, DVA Paperless, and DVA Allied Health claims.

6. If the data isn't ready yet, you will be able to return to this claim later and re-send the payment report request to Medicare:

   

Accessing Reports For Multiple Claims (Batch Processing)

1. From the Medicare Dashboard, use the provided filters to select all the claims you want to include.
   
   

2. Click 'Request Payment Processing Reports' button to request the data from Medicare. Allow for some time for the data to be generated and received from Medicare

3. After the report is run, the report status will tell you where your claim is in the process. When on Tools > Medicare Dashboard, you can see whether a payment status report has been run for a particular claim by looking at the 'Paid' and 'Run Number' columns on the very right corner of the table.

• • If it says "Not Run", it means that the report has not been run for that particular claim.

  • If it says "Not Run/Not Available", there may be a problem with the claim.

  • If the claim has been processed, you will see the $ amount in the 'Paid' column to show how much Medicare paid for this claim.
  • If you see a 4-digit code in the 'Run Number' column, this means the report has been run successfully. This 4-digit code is the Payment Run Number; it will correspond to the payment identifier that was made by Medicare into your bank account.

4. To see payment details of each claim in the batch, click the 'View Payment Status Report' button to open the consolidated report page.

• You can use the available date filters 'Show Claims Sent From' to narrow down the claims to review. 
• The payment report includes the following columns: 
  • Claim Sent - the date when you submitted a claim to Medicare
  • Patient - client's full name, with a link to their profile in your Zanda account
  • Invoice Number - invoice which was used to generate a claim, with a link to this invoice edit page
  • Claim ID - Medicare claim ID, with a link to this claim's payment processing report page
  • Servicing Provider Name - name of a practitioner who provided this service
  • Provider Number - practitioner's provider number as registered in Medicare
  • Charge Amount - amount charged on an invoice 
  • Paid Amount - Medicare benefit paid to your provider's bank account
  • Run Number - payment run number provided by Medicare, corresponds to the Medicare payment description in your bank account
  • Date Paid - date when payment was processed by Medicare
  • Payment Assigned - if checked, the received payment was automatically assigned to the corresponding invoice by Zanda (see below)

5. To check the payment processing report for an individual claim on this list, click the Claim ID link. Repeat the steps provided above for viewing a report for a single claim. 

Recording Payments Two Ways

After you've run a Payment Status Report, you can record the received payments on your Zanda invoices. You can do this either automatically or manually.

Option 1: Automatically Allocate Payments

This is an optional but highly recommended feature that saves you time by automatically matching payments to invoices.

1. Navigate to your Tools > Medicare settings.

2. At the bottom-left of the page, switch on the slider for the claim type you want to enable (either Bulk Bill or DVA, or both).

3. Select the payment method to be used for these payments.

4. Click "Save Changes".

☑️ Once enabled, each time you fetch a Payment Status Report, the system will automatically create and allocate a payment to the corresponding invoice for any claims that were paid. The payment will be dated based on when Medicare made the payment to you, and the payment note will include the payment run number for easy reference.

Option 2: Manually Record Payments on Single Invoices

You can also choose to record payments on each invoice separately.

1. Go to Tools > Medicare dashboard.

2. After running the report, check the "Amount Paid" column to see what has been paid. You can also reference the "Run Number" for a number that will correspond to the payment that was made by Medicare into your bank account.
   
   

3. Click on the "Invoice Number" to access the Edit Invoice screen.
   
   

4. Use the "Add Payment to this Invoice" function to add a payment for the amount paid.

   1. You may need to add "Bulk Bill" as a new payment method to your account by going to Settings > Payments > Payment Methods.

Navigating Explanation Codes

Medicare Service Response explanation codes are the heart of the Payment Processing Report. They are short codes provided by Medicare and DVA to tell you exactly what happened to your claim.

You'll see these codes and their corresponding descriptions in the processing reports:

If you encounter an explanation code and are unsure what it means, the best way to get a complete explanation is to check the official lists provided by Services Australia.

• Official Medicare Explanation Codes List: Look up a Medicare reason code

• Official DVA Explanation Codes List: Look up a DVA reason code

Common Troubleshooting

• "Report Not Available" after 72 hours: This can sometimes indicate an issue with your provider number registration. It's a good idea to confirm that your provider number and bank account details are correctly registered for bulk billing with Medicare.

• Batch Processing Failures: If your batch report fails, it's often because some claims in the batch were ineligible. The system won't process claims that already have reports, are the wrong claim type, or are not in the "Referred" status. Simply filter out the problematic claims and re-run the batch.

• Requesting a Report Too Early: If you requested a payment status report before Medicare had issued it, you will need to manually check each claim individually later. The system will not send a new payment report request for the claims that were already included in the previous, failed request.

• Missing Explanation Codes: If codes appear without text, they may be unknown or unmapped. Refer to Medicare documentation or contact them for clarification.