How to process Child Dental Benefits Schedule in EXACT.
Note: If you are using HICAPS Trinity Terminals to process CDBS claims, please ensure you are on version 13.1010 of EXACT or above.
Related Help Article: Install HICAPS Connect Version 4
If you are setting up Easyclaim for the first time in EXACT, please see here instead: Medicare: Child Dental Benefits Schedule (CDBS) Easyclaim setup
Note: For details about the Australian Medicare Child Dental Benefits Schedule, please visit:
- Setting Up a CDBS Patient In EXACT
- Invoicing a CDBS Patient
- Claiming For Medicare CDBS Easy Claim Items
- Manually Entered CDBS Claims
- Entering The CDBS Payment
- CDBS Easyclaim Payment Allocation
- Medicare, CDBS Easyclaim Setup
Setting Up a CDBS Patient In EXACT
In the patient details tab, on the right-hand side you will see Medicare IRN.
This is where you will set the patients IRN or individual reference number. Please enter the number with no leading zeros.
If you click into the i you can now manually enter the patient’s full Medicare card number and select OK.
Ensure the Medicare card number is entered with no spaces.
Invoicing a CDBS Patient
For the Medicare CDBS easy claim to work, the practice can only invoice the CDBS payor.
|Note: If there is any patient portion at all this will not be able to go through the HiCAPS terminal automatically.
Create your treatment plan as per normal, selecting CDBS as the Payor and Charting/Invoicing with the 88 Service item codes, which can then be claimed.
Note: CDBS Easyclaim can only be processed on the day of the invoice. If it is a day later, you will need to process this manually by swiping the card into the terminal, and following the prompts via HiCAPS.
Claiming For Medicare CDBS Easy Claim Items
Once the 88 Service item(s) are Charged/invoiced within EXACT, against a the CDBS Payor, you can take payment as per normal, and select the HiCAPS icon.
This screen will show the Medicare Easyclaim tab to the right of the HICAPS tab, and will allow you to send the "Easy Claim" through to the Terminal to be claimed.
Click the Send Medicare Easyclaim Claim button, in order to send the claim details to the Terminal for processing.
You will be prompted for Referral and Request Details, you do not need to enter anything into this screen unless there is a difference in Claimant - you can just click OK.
This will then connect to the HICAPS terminal and print out a receipt showing the bulk bill claim. This is NOT confirmation of payment. This just shows that the claim has been submitted to Medicare.
Usually, the practice does not receive payment into their account for a couple of days.
If the practice needs to alter the invoice after the claim has been processed, the site will need to use the Cancel Item button for the Medicare CDBS claim.
|Note:This will not cancel the claim with Medicare, it will only cancel this through EXACT so the link to the invoice is broken. Allowing them to resubmit/delete the invoice and correct it. If they have altered the items they are wishing to claim, they should call Medicare to notify them.
Manually Entered CDBS Claims
If a claim has been declined and practice decides to do a manual claim. There is no communication between HiCAPS and EXACT, so it is not possible for EXACT to know that a manual claim has been done.
No lines need to be added on the payment screen to show manual claiming. However, if there are more items to be claimed on the same day, you might notice that the items that are already claimed manually are shown in the Medicare easy claim section.
Please ensure to untick them so that they will not be resent to HICAPS machine for re-claiming.
Entering The CDBS Payment
Once it has been confirmed that Medicare has paid the account, you can make payment through the CDBS payor area.
Open the CDBS payor transaction screen ($) and select payment.
Enter the amount you have received, then find the correct patient you are making payment for and select the box next to their name.
You can then alter any other details like the provider, or the date if they have authority and are wishing to change the date.
We recommend adding a comment so it is easy to track the patient’s payments.
Comment(s) could take the format of: Patient first and last name
CDBS Easyclaim Payment Allocation
It is important to do this step so that the payor balance is reconciled. The CDBS invoices will not be paid to the provider (if using the allocated payments report to pay the provider) until these payments are allocated.
Charting, charging & claiming through HICAPS.
Processing payments after amount is received into the bank account from Medicare.