MBSPro can be used to perform an Eligibility Check for MBS items to help patients make informed decision on their treatment.
The purpose of this is that you can accurately assess whether a patient is eligible for certain items and provide informed financial consent on the cost of these items.
Follow these steps to conduct a check: Remember once you have performed an item number check you need to print out the report and give to the patient as well as put a record of the transaction in the patient file.
- Patient medicare eligibiltiy check: Go to the MBS Planner on the right and click the Eligibility Check button 🔗.
- Enter Patient and Provider Details: A pop-up screen will prompt you to input the patient's details along with your provider number.
- Click Submit
Click submit to receive a statement of claim 🧾, showing the benefits payable. This lets you confirm if the patient is eligible for rebates on items like care plans and health assessments ✅ and what their out of pocket expenses would be if any.
A list of Reason Codes can be found at Services Australia.
For more details, visit the PRODA Education website for health professionals 📚 below
Certain Medicare-related functionalities are not handled by MBSPro. These include:
- Statement of Claim and Benefit & Lodgement Advice: MBSPro does not submit or manage claims. However, you can generate a printed disclaimer with OECW/ECM response information for patient communication. This statement of claim should be given to the patient and placed in your medical chart
- Resubmission of Rejected Services: Claim resubmission is not part of MBSPro's functionality. Please reach out to your billing software provider directly
- Reporting and Reconciliation: Financial reporting and claim reconciliation are not managed within MBSPro. MBS Pro Proda check only allows for informed financial consent of patients regarding item numbers
Services Australia requires us to provide the following definitions:
a. A Statement of Claim and Benefit is provided to the claimant when a Patient Claim has been lodged in real time, processed by the agency and a benefit amount returned to the claimant. b. A Lodgement Advice is provided to the claimant when a Patient Claim has been lodged in real time and referred to an agency operator for action.
Below is a video showcasing how the medicare online services eligibilty checker can be used
For further support details regarding using MBSPRO, PRODA and Medicare online/eclipse to check item numbers please reach out to Hello@mbspro.com.au