Provider numbers for Medicare and DVA
This page applies to both Medicare and DVA claims as they both use the integrated claiming service provider.
Provider numbers
There are three provider numbers that may be required:
- A servicing provider number is required for all claims.
- A payee provider number is required for Medicare bulk bill and DVA claims.
- A referral provider number is required when Service Type is S (Specialist).
This is sourced from the employee linked to the invoice costs, not the logged on user.
This is sourced from the office linked to the invoice.
This is sourced from the referrer case contact.
Servicing provider numbers
This is the provider number for the employee linked to the invoice costs. There can only be one servicing provider number per invoice so all the invoice line items (costs) must link to the same employee.
Additionally, employees have different provider numbers for each office they work from. Thus, in practice all the costs must have the same office and the same employee.
A claim where all invoice cost line items do not have the same employee provider number will fail.
Employee provider numbers
One employee can have more than one provider number stored in Case Manager, depending on how and where they work. All but one of these is stored at the case category level.
For each cost, Case Manager looks for the employee's provider number in three places, starting with the most specific location and ending at the most general. It poses three questions and stops when it gets an affirmative reply.
- Is a provider number set at the category for this employee at this office?
If yes, this number applies and the search is over.
If not the search goes to step 2.
- Is a provider number set at the category for this employee?
If yes, this number applies and the search is over.
If not the search goes to step 3.
- Is a provider number set for this employee at the Employee List?
If yes, this number applies.
If not, no provider number can be located and the claim or rebate payment will fail.
Set up employee provider numbers
The method for setting up provider numbers for an employee depends on how you run your business.
One provider number
If an employee only needs one provider number for all their work you can simply store their provider number at the Employee List.
One provider number per category
If the employee needs different provider numbers for each case category you set these in the Category List for all categories involved.
Select Lists > Other Lists from the main menu and select Category from the List type dropdown list.
For each category, select it in the list and click its Accounting tab.
Enter a category-specific provider number for the employee at the Employee provider numbers tab.
Multiple provider numbers per category.
If the employee works out of multiple offices, add provider numbers for each category at each office via the Employee - Office provider numbers tab.
More general details about provider numbers in Case Manager are at Provider numbers.
Payee provider numbers
This is the provider number for the office linked to the invoice costs.
Office provider numbers
Every case is linked to an office, which is a member of the Office List. However, you do not set the office provider numbers in the Office List.
Instead, each office has one provider number per category. So you set up office provider numbers at a case category level.
As above, open the Category List by selecting Lists > Other Lists from the main menu and then selecting Category from the List Type dropdown list. Select the category in the list. Locate the category's Accounting tab and then the Office provider numbers sub-tab.
- You can set a default provider number for this category and all offices.
- This number is overridden when a particular office has its own provider number.
Note that when a provider is self-employed and the claim is a Medicare bulk bill claim, a Payee Provider number should not be entered in the Category List. The submission will fail because the Servicing and Payee numbers are the same.
Referral provider numbers
This is the company provider number for the referrer for the case, i.e. the case contact with the role of Referrer.
Contact provider number
You can see this in the case contact's Other details area, where it is found next to another company-level field, the web site.
You set a contact's provider number at the company level. Locate the contact in the Company List and click their Company Settings tab. If you cannot locate the contact in this list check your settings for the Company List Criteria.
You can also enter a contact's provider number when you add a new contact to the case. This is a new contact, not an existing contact that you are connecting to the case. For the new contact the provider number is still stored at the company level but you can enter it at the case screen you are using to enter the new contact's details:
