Billcode changes in v 3.4

Four new billcodes have been introduced for health fund billing.

Three of the billcodes are available for each of Qld, NSW and Vic, the other one applies to all states.

  The new billcodes are called 1. ‘Fund - Maximum, Known Gap’ 2. ‘Fund - Practice, Known Gap 3. ‘Fund - No Gap’ 4. ‘Fund - Practice, Schedule’  

‘Fund - Maximum, Known Gap’ will price at the absolute maximum the patient’s health fund will allow without falling outside the ‘Known Gap’ pricing arrangements. If this isn’t applicable to the selected health fund or if it’s not possible for us to calculate an absolute maximum then the prices for those health funds will be calculated as $0 to indicate this billcode is not applicable.

‘Fund - Practice, Known Gap’ will price at the practices usual Practice fee, or a lower amount if required to stay within the ‘Known Gap’ pricing arrangements for the applicable health fund. If this isn’t applicable to the selected health fund then the prices will be calculated as $0 to indicate this billcode is not applicable.

‘Fund - No Gap’ will price at the selected health funds no gap price. This billcode is applicable to most health funds, however if it is not applicable to the selected health fund then the prices will be calculated as $0.

‘Fund – Practice, Schedule’ will price at the practices usual Practice fee, and the rebate will be calculated using the MBS Schedule. This billcode can be selected when pricing outside of the fund No Gap and Known Gap pricing arrangements and where the selected fund will drop its rebate to the MBS Schedule fee.

These new billcodes cannot be modified in any way other than being made inactive if they are not required. If any errors or omissions are included in these billcodes please contact Stat support so an adjustment can be for you to download into your copy of Stat. It is possible to copy any of these billcodes to a new billcode and then make any changes you wish. If you do copy any of these billcodes then any future updates distributed by Stat to the built in billcodes will not affect the copies you have made.

When changes are made they will be downloadable just like MBS prices and immunisations are now.

As part of these changes there has been a significant number of additional options added to the billcode fee details setup. These changes can be used by practices in their normal fee calculations for non-health fund billing. After the upgrade to this version of Stat we would recommend that you make the old billcodes inactive.

The quoting, billing, invoicing and claiming processes all remain exactly the same as they were before, it’s just the names of the billcodes and the ways their prices are calculated that has changed.  

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