Claims

Last updated: March 6th, 2019

A patient presenting to your clinic will either have an existing claim or you will need to generate a new claim. In order to generate new claims electronically, first add a claim number range to a vendor.

Completing new ACC forms

Depending on how your want to operate, SubmitKit supports a number of options for creating new claims. Claims can be added on the go, or retrospectively at the end of a time period eg. weekly.

Retrospectively
  • Using a custom paper ACC form. Create an ACC form or use our form templates: The form will need to contain the relevant fields needed for ACC, which the patient must complete and sign. Then when it is time to lodge your claims, generate a claim number, and enter the relevant patient and claim details, submit the claim to ACC through SubmitKit.
  • Use the standard ACC45 paper forms and use the claim number off the form. This requires manually entering claim numbers into SubmitKit and your patient needs to complete some fields twice eg. date of birth, address, if these are also on another form. You can either post these claim forms to ACC and when the claim has been processed you can import the claim. If still want to lodge the claim electronically you can use the claim number off the paper form and lodge the the claim through SubmitKit.
As you go
  • Enter the claim details directly into SubmitKit. Then have the patient electronically sign the form, or print the form for the patient to sign
  • Have the patient complete and sign the form on a device. Learn more about using electronic devices for forms

Creating claims

Head to Appointments click 'Add Claim' or

Head to Patients find patient, then click 'Add Claim'

Creating new claims

Generate a claim number by clicking the 'New' button as shown above. You need to have a claim number range entered for the vendor for this to work.

New claims need to have all the required patient and claim detail fields entered before submitting them to ACC. Required fields have a green border on the left of the text box, as shown or have a next the field label. On the patient form, email address is optional. Employment details (employment type and intensity) are required for patients in paid employment, but employer details are only required for work related accidents. On the claim form, all fields are required, from the claim number to the diagnoses. Gradual process, Admitted to hospital, Medical treatment injury, and Acc to contact provider are required but are pre-populated to 'No'.

Once all patient and claim forms are completed click . If any required fields are missing you will receive an alert. Once the form is submitted to ACC, the claim and patient will be automatically saved. If there are any errors you will receive an alert showing what the error is. Correct the error, then re-send.

Employer details

Employer's name and address are only required for work related accident claims.

Address requirements

Line 1, city and post code are required for addresses. These can be easily populated using the address auto-completion built into SubmitKit. If an address has missing information like a post code but you have the street address in address line 1, you can click into the line 1 of the address and hit back space - this will bring up the address to be selected. Selecting the address will then auto-populate the required fields. If the address you have doesn't have the street address in line 1, then enter it in line one.

Add an existing claim

Adding existing claims

Existing claims can be added using just a ACC45 claim number. Enter a claim number and make sure that a practitioner and provider type are selected. These will be auto-populated if the form has been opened from the appointments page.

Click on the 'import' button as shown above. The date of accident and diagnosis fields will be pulled from ACC and the existing claim checkbox will be checked. If the details are correct click 'save'.

If a claim is not found, it could be that the claim has not yet been registered with ACC, or the claim number is wrong.

If you know how many treatments a patient has previously had on a claim for the provider type selected, you can enter the number of treatments in the 'OTHER' column. Also if you know the date, or can approximate the date of the first treatment, this can be entered into the 'FIRST TX' column. Entering in these details helps determine when a claim expires; this information is not sent to, or used by ACC, but is for your own reference.

Expiry date

When importing existing claims, expiry date will be set to 12 months after the date of injury and the estimated tick box will be ticked. Estimated expiry dates will be highlighted yellow wherever they appear. If this is the first time the patient is seeing this provider type, you can set the first treatment date, or double click the first treatment date if today is their first treatment date - this will set the expiry date and un-tick 'Estimated Expiry'.

Add an existing claim

Import previously used claims

If you or another ACC billing system you have used has been placing claim numbers in the appointment 'Note' field or patient 'Invoice extra information' field, these claims can be pulled through to SubmitKit to be used. The 'search' button will find any claim numbers entered into the aforementioned fields.

Cliniko example of claim number in 'Note' field

screenshot

If there are any claims stored in the 'note' field they will be displayed in a table, which contains:

  • the claim number
  • the provider type of the practitioner who treated the patient
  • how many treatments that provider type gave for the claim
  • the date of the first treatment
  • the date of the last treatment
Click on the 'import' button to pull through the details of the claim from ACC. The first treatment date and how many treatments have been given will be set for the claim, but these may need to be adjusted if the patient has been treated for the claim at other clinics. If the patient has seen more than one provider, click on the provider type that is the same as the one creating the claim. If the patient has not seen the provider type that is creating the claim, it is fine to import the claim number that is showing a different provider type.

After importing, save the claim.

Bulk import claims

Contact us if you wish to import a list of claims to get you started with SubmitKit.

Non-ACC claim details

Claims can be edited via the claim pop-up form or through clicking 'edit' on a claims page. Non-ACC fields for a claim are at the bottom of claim forms. The non-ACC section is used for your own management and tracking of claims.

Inactive claims

If you no longer need to invoice on a claim, eg. the patient is better or has a new claim, the claim should be set to in-active by deselecting the active check box. Inactive claim will be hidden from being selected on the appointments page. Claims can be reactivated by checking the active checkbox.

Claim treatment counts

Treatment counts keep track of how many times a claim has been invoiced, as well as managing the expiry date of the claim. Claim's expiry date is set to one year after the first treatment date for each provider type. For new claims, first treatment date will be set automatically for the provider type creating the claim. For existing claims, the first treatment date should be set for each provider. If you want a claim to become inactive when it expires or when all the treatments are used up you can set this in the 'Treatment Counts' section or from the dashboard.

Extending treatment counts

If you have an extension for the number of treatments for a provider type, this can be added to the 'EXTEND' column. On approval of an ACC32, the 'EXTEND' column is where you add the number of treatments the extension specifies.

Custom treatment count

If a claim has a custom number of treatments, eg. the number of treatments has been set by an accredited provider, enter the maximum number of treatments in the 'Custom treatment max' field.

Accredited employers

Check accredited employer, and select or create an accredited employer if the claim is handled by an accredited employer/provider. Learn more about working with accredited employers.

Claim status

Claims created in SubmitKit can have one of five statuses. Colour codes are used throughout SubmitKit to help identify which state a claim is in.

  1. Pending claims are claims that have not yet been submitted to ACC. This could be because the claim has not yet been submitted by your clinic, or it is an existing claim that is not yet registered with ACC.
  2. Registered claims are existing claims that have been registered with ACC.
  3. Submitted claims are claims that have been submitted to ACC through SubmitKit by your clinic.
  4. Accredited claims are claims that have been marked as being handled by an accredited employer.
  5. Failed claims are claims that have not yet been registered with ACC, due to an error in submission.
  6. Declined claims, are claims that have not been accepted by ACC and that you have marked as declined

Viewing and Editing claims

Claim list

Head to Claims

Claims in the claim list will be sorted by date created with the most recently created claims at the top. You can also sort by date of accident, or filter claims to claims of a particular status.

You can search for a claim by patient or claim number

Clicking the claim number will take you through to the full details of the claim.

'Edit claim' will bring up the claim pop-up form.

'Delete claim' will delete the claim if it is not used in any appointments.

'Status' will check the status of a claim, and update it if applicable, eg updating from pending to registered.

Clicking on the active column will toggle the claim between active and in-active

Claim page

Treatment counts by provider
  • Provider
  • Expiry Expiry date for that provider. If yellow the date is estimated
  • Remaining The number of treatments remaining
  • Info. Hover over to give a breakdown of the treatments invoiced
Appointments for this claim

This shows the appointments which the claim number is set for. It shows both invoiced and un-invoiced appointments.

Buttons:
  1. Select All
  2. Select none
  3. Create comma separated value file from selected appointments
  4. Create excel spreadsheet from selected appointments
  5. Create a multiple line accredited invoice from the selected appointments

Accredited invoices will only be created if the claim has been checked as a accredited claim. More about accredited invoices. Use the check box on the left to select a custom number of appointments. Then if you wish to create an invoice with multiple invoice lines, click the accredited invoice button.

Treatment notes report

You can generate a treatment notes report for a claim. The report will contain all the treatment notes from Cliniko that relate to a claim. A claim is associated with an appointment once is set in SubmitKit.

Some treatment notes will not have a template in Cliniko, eg if you are uploading claim details from SubmitKit, if you wish to include those treatment notes in your notes report, tick the 'Include treatment notes that don't have a template' tick box

Printing, Emailing, Uploading claim forms

Clicking the 'Claim Form Actions' button at the bottom of the pop-up claim form will bring up the Print/Upload/Email menu.

Print/View claim form

Clicking the Print/Veiw options will open a pdf of the claim form in a new browser tab.

  • The 'Client Copy' includes the patient declaration on the form
  • The 'Provider Copy' will have the additional 'ACC to contact me' field, which should not be shown to the patient, and will exclude the patient declaraton
  • The 'Referral Copy' will have the clinic details, as set on the 'Vendor' page, and a place for the practitioner to sign
  • The 'Client's Edit' will only show if the patient has completed the form on a device, and will have the patient's signature if they have signed the form.
Upload form

This is for uploading the claim form to Cliniko if you wish to keep a record of your claims in Cliniko. The form will be upload to the 'Files' section of a patient.

  • The 'Provider Copy' will have the additional 'ACC to contact me' field, which should not be shown to the patient, and will exclude the patient's declaraton
  • The 'Client's Edit' will only show if the patient has completed the form on a device, and will have the patient's signature if they have signed the form.
Email form

If the patient wants their claim details, and has an email address entered you can email them either:

  • the claim number by clicking the 'Claim Number Only' button
  • or a pdf copy of the claim form by clicking the 'Full Claim Form' button.

Submit a change of diagnosis to ACC

Head to the page of a claim and click 'Alter Diagnosis'.

The change of diagnosis page is for adding a new diagnosis to a claim that has been submitted, or changing or deleting an existing diagnosis.

Select practitioner

First select the practitioner and provider type making the change request.

Adding a read code

Click 'Add Read Code'. Enter a read code and side of the body. Adding a comment is optional.

Remove a read code

Click the . The line will be highlighted red to indicate that the read code is to be removed by ACC.

Alter a diagnosis

Change the read code or side on a previous diagnosis.

Set a primary

All the actions - adding, removing, changing - require that one read code be set as the primary.

Submitting alterations

Click the 'Submit Changes to ACC' button.

ACC change requests

Any alterations sent to ACC are requests for changes and they will need to be approved. Alteration requests won't change any of the diagnoses in SubmitKit. Changes would need to be made manually once approved by ACC.