Claiming Hospital is used to transmit the invoiced episodes to the health funds via ECLIPSE. It consists of 2 tabs, Claims & Not Yet Sent.
These instructions will cover the Claims Tab.
For information regarding the Not Yet Sent Tab see our instructions Claiming Hospital – Not Yet Sent

1. The Claiming Hospital section can be opened by hovering over the and selecting Claiming Hospital.
2. This will open to display the Claims tab which is where all the claims that have been transmitted to the health fund are displayed. It will open to show all outstanding claims. Claims that fall under the category of Receipted or Payment Received are not displayed by default when the page is open. (These categories will be touched on later in the instructions)
3. For multi-location systems, use the Location dropdown to select the desired location
4. The Provider dropdown gives the option to select a certain doctor/surgeon
5. The Status dropdown allows the ability to display the claims according to their current status. (This status refers to the ability of the claim to be sent to the health fund. It is not a response from the health fund. The responses will be covered in the instructions Processing & Payment Reports)
   a. Open
   b. Closed
   c. Closed with Issues – There was a problem sending the claim
   d. Ready
   e. Queued – The claim is waiting to be sent to the fund
   f. Sent (white) – Has been sent to the fund less than 2 weeks ago or the fund has responded
   h. Sent (red) – Has been sent to the fund, but no response has been received for 2 weeks
   i. Processed – The fund has processed the claim
   j. Payment Received – The payment has been received
   k. Receipted – The payment has been received & applied
   l. Rejected – The claim hasn’t been received/accepted by the fund
6. The Fund dropdown allows filtering to a particular health fund
7. The Search field gives the ability to search any information e.g., batch number, invoice number, patient name, amount claimed or paid etc
8. Hovering over the words Closed with Issues or Rejected will display a pop up that will give more information as to why the claim wasn’t successfully transmitted
9. Clicking on the Invoice Number will open a new tab & display the health fund response, if it has been received, in the Processing IHC screen. Information on this tab will be covered in the Processing & Payment Reports instructions
10. The blue arrow on the right of the screen, & also the Right Click feature, gives the option to go to the patient History screen, if you need to view the episode details. The Right Click function also allows the user to Remove Batch. However, this would only be utilised if the health fund has confirmed that it didn’t transmit successfully & they will not be making payment towards it. The batch is what allows the system to link this claim to the invoice number. Therefore, if a batch is removed prematurely, the associated invoice number will not display on the Electronic Remittance Advice when it is received from the fund. This makes it very difficult, & a lot more time consuming, to receipt a remittance so we do not advise to remove sent batches without liaising with the health fund first.
11. As mentioned earlier, the Claims screen displays all claims Except Receipted & Payment Received when opening. Therefore, as soon as a payment has been processed in the system the claim will disappear from this screen by default. This allows users to easily identify claims that are still outstanding. Claims with the status of Payment Received or Receipted can always be vied by using the Status dropdown mentioned in #5 above

Claiming Hospital is used to transmit the invoiced episodes to the health funds via ECLIPSE. It consists of 2 tabs, Claims & Not Yet Sent.
These instructions will cover the Not Yet Sent Tab.
For information regarding the Claims Tab see our instructions on Claiming Hospital – Claims

1. The Claiming Hospital section can be opened by hovering over theand selecting Claiming Hospital
2. This will open to display the Claims Tab. (Click on this link to view the Claiming Hospital – Claims instructions)
3. The Not yet sent tab displays all claims that have been invoiced & will include claims that can be sent via ECLIPSE & also Paperbase claims that need to be sent manually
4. For multi-location databases, use the Location dropdown to select the desired facility
5. Use the Type dropdown to select Eclipse or Paperbase claims
6. Use the Status dropdown to display, or omit, claims that are Ready, Not Ready or On Hold
7. Use the Fund dropdown to display, or omit, certain funds
8. Use the Coding dropdown to display, or omit, claims that are Completed or Pending coding
9. Use the DRG dropdown to show claims with a DRG or with an Empty DRG.  Using the Empty DRG option will identify claims that still require to be grouped
10. Use the Run Pat Check button to run an OPV Check for all the patients on the list. This function will only work if the patients’ Medicare card & health fund cards are entered correctly. Sometimes this may need to be run twice as the Medicare card might be updated the first time, therefore running it a second time will enable the system to check the fund details
11. For a claim to be ready to be sent it requires:
    a. A blue tick to confirm the OPV check has been successfully performed
    b.   A green tick to confirm that the coding has been completed
    c.  If it is still showing as Not Ready it will need to be grouped, in the coding screen
    d.   Once it is showing as Ready it is able to be transmitted via eclipse
12. Use the Blue Arrow , or select the claim (so that it is purple) and Right Click to display a menu that allows you to navigate to: – The Coding Screen to check coding & grouper
    – The Patient History Screen to view the invoice details
    – The Patient Record Screen to complete the OPV check
    This feature assists in getting the claims ready to transmit via eclipse
13. When an ECLIPSE claim is ready to be sent another option will be available in the menu called Send Invoice via ECLIPSE which will then send the invoice to the fund
14. Once all claims are ready to be sent (or filters have been applied to only show Ready ECLIPSE claims) the select all function will be available to select & send multiple claims at once
15. After all desired claims have been selected, use the Select dropdown to Send selected via ECLIPSE
16. The claims will then be transmitted to the fund & will display on the Claims tab with their status. It is a great idea to check the Claims Tab straight away to make sure claims have been successfully transmitted
17. Paperbase claims will also appear on the Not yet sent Tab. This is to remind the user to send the claim away manually.
18. Paperbase claims will require the coding to be done & the episode to be grouped before it will show as Ready
19. Once it is ready, the blue arrow on the right, or the right-click function, will display the option to Mark as Sent. Using this function, only after the invoice has been manually sent, is a great way to ensure no claims are missed. Once the claim is marked as sent it will no longer display on the Not yet sent tab. There will also be an audit in the Patient Episode Screen to state who marked the claim as sent & when.

These instructions will assist users in adding or amending the fees associated with Other Service Codes / Prosthesis Codes.
Prostheses list updates will be automatically loaded into FYDO and any new items will be added with all new fees will be imported. However descriptions will not be updated, as some facilities prefer their own descriptions & do not what them overridden.
After following the instructions for Adding Other Services Codes the user will be able to add the correlating fees by following the steps below.

1. Go to Settings
2. Scroll down to Hospital > Fees Management & select Other Services
3. Use the Search field to find the desired code / other service
4. Double click on the item to display the information that has been entered, along with the table to enter the relevant fees

5. If replacing fees that have already been entered, use the Action dropdown & select Move all Current Fees to Old Fees. This will copy the Current fees to the Old fees to allow the new fees to be entered, without losing the previous fee schedule or needing to type them in again
6. If the cost of the item will be the same for each health fund, enter the charge for the first fund under the Charge inc GST column
7. Then use the Action dropdown & select Make the First Charge the same for the rest of the Funds. This will replicate the fee added for the rest of the funds
8. Then use the Action dropdown & select Move Current Charge into Current Rebate. This will replicate all the Charge inc GST fees in the Rebate column. You may then need to remove some of the fees listed in the Rebate column (or override them to $0) if the ‘fund’ doesn’t attract a rebate (e.g., Uninsured)
9. Use the GST tick box column if the fee entered is inclusive of GST
10. If the cost of the item is for a particular ‘fund’ (e.g., a gap fee for an uninsured patient), add the fee to the desired fund, instead of following the above steps to add to all funds
11. Lastly enter the Threshold Date (start date) 
12. If an Other Service item can no longer be used for billing/claiming, you can allocate an Expiry Date
13. If the item should always be billed to the patient, you can set this as the default by selecting Patient in the Send Invoice To dropdown.

5. Once all desired information has been entered click SAVE

These instructions will assist users in Adding or amending an Other Service Code / Prosthesis Code for the purpose of updating the description or information related to the item.
Prostheses list updates will be automatically loaded into FYDO. Any new items will be added & all new fees will be imported. Descriptions will not be updated, as some facilities prefer their own descriptions & do not what them overridden.

1. Go to Settings
2. Scroll down to Hospital > Fees Management & select Other Services
   
   

   

   
   

3. Use the Hospital Drop Down box to select the facility if it is a multi-location database
4. Use the All Services Drop Down box to select a specific service type, if necessary
5. Use the Search field to determine if the code is already in the system. The search fields can be used to search codes, descriptions or companies etc to allow the user to search any part of the other service information
6. If the code appears, double click to display the information. If it doesn’t appear, use the Show Inactive tick box to be sure that the code isn’t in the system as Inactive
7. If the code needs to be added, click Add Other Service
   

   

   
   

8. Enter the Billing Code. (This is the only information that will not be editable once the item is saved)
9. Enter the Description (Mandatory Field)
10. Use the Type dropdown to categories the item:
    a. Allied Health Services
    b. Disposables
    c. Labour Ward
    d. Nursing Fee
    e. Other
    f. Pharmaceuticals
    g. Prostheses
    h. Theatre Fee
11. Enter the Company that supplies the product. (This can assist with reporting on prosthesis etc, as the other services reports can be run by suppliers)
12. Enter Eclipse Mapping if the Other Services code that is being entered requires a prefix before the code itself. (Only add the prefix to this field, not the prefix & the code)
13. Use the Exclude fee when billing tick box if this Other Service is excluded from certain Casebase contracts. For example, if the contract lists an all-inclusive fee for a procedure, that also includes prosthesis, this tick box would ensure there is no fee raised for this particular prosthesis when billed in conjunction with the particular Casebase item. For this feature to work the tick box in the Casebase Fee Set up called Exclude Other Services also needs to be ticked. When these two tick boxes marry up there will be no charge raised for the other serviced when billed with that item. For any other Casebase or per diem fee, without this Exclude Other Services tick box marked, there will still be a fee raised for the other service
14. If an Other Service item can no longer be used for billing/claiming, you can allocate an Expiry Date
15. If the item should always be billed to the patient, you can set this as the default by selecting Patient in the Send Invoice To dropdown

16. Use the Status to mark a code as Active or Inactive
17. Once all desired information has been entered click Save
18. The Export to Excel option allows for the other services, along with the fees for each fund, to be exported to an excel spreadsheet. Use the Search field to filter down to a particular company or description etc to export more specific data (e.g., Search Alcon to export a list of all prosthesis in the system with the company listed as Alcon)
19. To Delete an item, use the cross in the Action column to delete. You will then be asked to confirm that you are sure you want to delete the other service.

The Other Service / Prosthesis Code has now been added to your FYDO database.

For information on how to add the associated fees to this new item please see instructions Adding Fees to Other Services Codes (Hospital).

For an invoice that has been incorrectly billed or needs to be reversed by way of a journal entry. Navigate to the required patient using number 1 or 2 below

1. Select Patient tab in the left-hand menu
   1. 1. Search for the required patient using the field in the top right
      2. Double click on required patient
      3. Navigate to the Episodes tab across the top of the patient record
2. Select Appointments tab in the left-hand menu
   1. 1. Search for the required patient using the field in the centre at the top or
      2. Use the calendar to navigate to the episode date
      3. Once the patient has been located, right-click on their appointment & select History
3. Ensure that the correct episode is selected from the list at the top
4. Ensure that the correct invoice is selected from the information for that admission (NB this is important if there are multiple invoices for the one episode)
5. Use the Invoice Options drop-down on the left of the screen
6. Select Reverse Invoice
   
   
7. The Reverse Invoice window will appear. Click on the invoice that you wish to reverse & it will turn a light shade of blue
8. Click the Reverse Invoice option
   
9. The invoice will continue to show in the episode; however it will now be followed by the journal adjustments that have just been performed to revers it & zero it out
   

If a patient or health fund is required to be refunded the system will reflect this transaction by following these steps.

1. Go to Accounts in the main menu & select Adjustments
   
2. For multi-location systems, use the drop down to select the relevant Location
3. Enter the required Transaction Date if it differs from the current date
4. Use the Type dropdown to select Refund
5. Once Refund is selected for the Type, the Payment Type field will be displayed so the method of the transaction can be documented
6. Type the required information in the Drawer field
7. Use the Reference No., Bank & Branch fields, if the facility work instructions require, to document additional information regarding a bank cheque etc
8. Click “Click to Search for an individual Account” and the search box will be displayed to find the required patient
9. Once a patient is selected, the invoices with an outstanding amount will be displayed
10. Use the Show All Invoices option to display invoices that don’t currently have an outstanding balance
11. Type the amount to be refunded in the Allocated column
12. Once you have moved from the Allocated field the system will show you the Possible Balance of the invoice, following the adjustment
13. Once all details have been confirmed & are correct click Save
    
    

Adjustments via the Adjustments Screen

If an adjustment is required for refund, write off, incorrect billing purposes etc it can be done using the Adjustments Screen or from the Patient History / Episode screen. Both options are explained below.

Making the entry from the Adjustments Screen

1. Go to Accounts in the main menu & select Adjustments

2. For multi-location systems, use the drop down to select the relevant Location
3. Enter the required Transaction Date if it differs from the current date
4. Use the Type dropdown to select the required transaction type e.g., write off, incorrect billing, discount, refund etc.
5. If Refund is selected as the Type, the Payment Type field will be displayed so the method of the transaction can be documented. For all other journal / adjustment Types this field will not be necessary & won’t be displayed
6. Type the required information in the Drawer field
7. Use the Reference No., Bank & Branch fields, if the facility work instructions require, to document additional information regarding a bank cheque for refunds etc
8. Click “Click to Search for an individual Account” and the search box will be displayed to find the required patient. (If processing this adjustment from the Episodes Screen any outstanding invoices will automatically be displayed)
9. Once a patient is selected, the invoices with an outstanding amount will be displayed
10. Use the Show All Invoices option to display invoices that don’t currently have an outstanding balance
11. Type the amount to be refunded in the Allocated column
12. Once you have moved from the Allocated field the system will show you the Possible Balance of the invoice, following the adjustment
13. Once all details have been confirmed & are correct click Save
    

Making the entry from the Episode Screen:

1. Search for the patient using the Search field or by selecting the required admission date & theatre
2. Right-click on the appointment & select Episodes
3. Once in the Episodes screen ensure that the correct date of admission is selected
4. Then use the Invoice Options drop down on the right of the screen to select Adjust Invoice

5. You will be redirected to the Adjustments screen where you can follow the instructions above from step 2.

PLEASE READ FIRST

This guide is intended for users who have too many or out of control debtors. This wiki page does not cover the basics, it is an in depth look at how to work through the debtors. 

First, lets run the report so we can identify patients that need to be investigated. There are 3 Filters we will want to use.

1. Fund – It may be best to look at one fund at a time, and action those together
2. Period – We can filter the report to only show us debtors that are 45 days and older, if your debtors is really bad you may wish to start at 60 days.
3. Details – Offers a detailed view of the report, showing patient information, make sure this is always on.

In the above example, I can see that there are some patients with outstanding debtors, ranging from 45 to 120+ days. The Balance Outstanding column shows me how much each outstanding patient has. The next step is to select one of these patients to follow up on, and we can go through the steps of what has to occur next.

Checking Invoice Status

The next thing we want to do, is head to the patients Episodes so we can see the details of the invoice, the outstanding amount and check the invoice status, so we know what part of the process the invoice had issues on.

To see the Invoice Status, simply select it from the Invoice Options drop down menu, found near the balance for that episode. As you can see below, the status will show us which batch the invoice is currently in, as well as what the Status of the batch currently is. The batch we have investigated below is sitting as Sent. As this episode was from 02/10/2020, this is probably not a good sign, so it is worth taking a further look into it.

There are three main Status’s you may run into:

• Sent – Invoice received no response
• Processed – Invoice has an exception file but no payment
• Rejected – Invoice was just flat out rejected

In all of the above cases, if a batch is old enough to be in the 45+ days Debtors and has an above status, it is time to call or email the Health Fund regarding its issue. They will be able to help with either resubmitting or amending the invoice, depending what is needed.

We also suggest making use of the Financial Notes, also found on the episodes tab. This will let you keep up to date notes, as well as allow all users to see the same notes, so you can track right on the patient record what you have done as a follow up.

Processing Reports

Once you have established that an invoice has an issue, it can be a good idea to check the Processing Report for that claim. Generally, these reports will include a rejection if there was one, and can help you figure out the issue. We can access the processing and payment reports section via the $ and selecting the appropriate option.

Once here, we need to select the Processing IHC tab at the top.

Now we will be able to view and filter processing reports depending what we need to look at. Make sure to select appropriate filters, since we may be looking at some processing reports we will need to use the From and To filter.

The important date to change is the From date. Since if you have this set to a recent date, Fydo will not display older processing reports. I suggest setting it to the date you sent your claim, so you know the processing report will be in range.

Since we are looking for a specific patient, you should then go ahead and search for that patient.

The can simply search by doing Lastname, Firstname. Now its time to look at the processing report, and try to assess why we were rejected.

Assessing the Processing Report

There are a few main things to look at in the processing report, covered below.

1. Claimed – This is how much you claimed for the invoice
2. Approved – This is how much the fund approved. $0 means a rejection, but you may also receive short payments as well.
3. Assessment – It is important not to just look at this field, as the fund has marked it Accepted, even though we clearly have a rejection. Make sure to look at all appropriate data.
4. Explanation – This is the important one, here you will see a brief description of why something has been rejected.

In the above case, I can see that for this patient, the service for 09/12/2020 was within the waiting period. My best bet would be to give MPL a call, and see if we are able to get it paid at all, since while we do know the rejection reason, there is no supporting information for how to get it paid.

In the cases of short payments, it is a good idea to compare the invoice you submitted to your Contract with the fund, and make sure you have charged the appropriate amount. If you have charged the correct amount, again contacting the fund is vital.

In almost all cases, it will end up best to contact the health fund, since many Explanations they provide can be unhelpful, or too short to convey the real reason for a rejection, as such they are the main contact for help, and can assist to get it paid.

Contacting Funds

See our health fund contacts page.

Medicare & DVA

Health Funds

Closing the ‘Accounting Period’ refers to locking down your financial figures up to a given date (usually the end of the month) so that they cannot be changed. 

We do not recommend closing the accounting period for the last month, on the first day of the current month. Rather, give yourself seven to ten days to get your figures to a point where you are happy. That is, after all rejections and adjustments are made. 

In other words, it ensures that the figures seen on your revenue report run out of FYDO match the figures seen on your bank account, to the cent. And that those figures then cannot be amended in FYDO. 

So let’s see where the accounting period is closed.

Start off by going over to settings.

Then, click Close Accounting Period.

 Enter the date you wish to lock your figures to and click Save.

This action is recorded in FYDO’s audit log, so you can see who closed the accounting period and when.

To view the audit log, go to Settings, then click on Logs.

You will see the log showing when the accounting period was closed.