DVA Claims

You probably know that Medicare processes claims for health providers on behalf of DVA.

Case Manager enables you to streamline invoice payments from DVA via the integrated claiming service provider. The process of making a DVA claim is similar to a Medicare Bulk Bill claim. You claim the full invoice amount from the DVA and when it is approved it is paid into your account.

Case Manager monitors the status of your claim and the outcome, including when it is paid.

Make sure that the most important invoice requirements listed at Setting up for DVA have been met before you submit a claim. You will be informed when your claim is missing any other required information. You can add this at appropriate place(s) in Case Manager and re-submit the claim.

Note that you will see references to Medicare claims in screens when you manage your DVA claim. This is because the integrated claiming service provider is being used to process the claim.

Submit DVA claim

To submit a DVA claim for an invoice select it at the client's Account tab. Note that the invoice must have Finalised status.

Locate the bottom of the invoice line item cost details.

  1. If you know that additional service information will be required, set cost flag(s) in advance by selecting the cost and clicking Flags.

    2. You will be offered different options for each service type, see Cost flags for details.

  2. Click Medicare Claim.

The Submit Medicare Claim window appears.

  1. You may choose to verify the client’s card before submission.

    2. If necessary you can click the row of dots (highlighted below) to open a window and edit the client's contact details.

    The DVA card number is stored in the client's Medicare number field.

  2. Select the DVA option.

  1. You should leave Authorized by client ticked.
  2. When required extra fields appear so that you can supply the information required by selecting from dropdown lists, entering text or clicking checkboxes.
  3. Click Submit.

Claim validation and submission to DVA

After you click Submit the claim is processed by Case Manager.

The first step is validating the claim details.

If your claim does not meet requirements you will be informed, for example:

In this situation click OK and correct the claim details (see notes about correcting errors below if needed).

In the example above the claim can be easily corrected to include the veteran's disability:

Once the claim has been corrected click Submit again.

The following message indicates that your claim has now passed validation and Case Manager has sent it to DVA.

Click OK.

You will now see that the claim:

  1. has a Claim Id
  2. has a status of Pending Update.

As the last step DVA either accepts or rejects the claim. This does not happen straight away.

  1. You can click Check Status at any time to check if there are any updates from DVA.

Note that you can also check the status of multiple claims at one time. See Check for updates to claims for full details.

There are two possible outcomes:

  • DVA accepts the claim and pays it.

    • In Case Manager the claim is given Complete status and payment details are displayed.

  • DVA rejects the claim.

    • In Case Manager the claim is given Failed status. The Medicare error code and any additional notes are displayed.

See Claim life cycle for further details, including DVA error codes.

If DVA rejects your claim you may be able to correct the claim details and try again.

Correct the claim details

Case Manager claim validation checks whether your claim details are invalid and/or incomplete.

The most important claim details are explained at Setting up for DVA. Note that if you need to change invoice details you will need to change the invoice status to Draft first.

For some services you are required to give extra details beyond the usual requirements, see Data mapping for an itemized list.

When the invoice's service type requires extra information you set cost flag(s) to supply this information.