Submitting DVA Claims

Important

You must fill out your HW027 form to register for Online Claiming. If you or any providers that submit claims through your account have not filled out this form previously please do so immediately. Details on how to fill out the form and submit it to Medicare can be found here. Please keep Question 3 on the form blank.

Once you have configured the DVA insurer, added your provider number(s) and recorded a client’s DVA details on their client record you are ready to begin submitting DVA claims through Power Diary. Follow on below to learn how!

In this article:


Submitting a claim

If you’re familiar with submitting Medicare claims through Power Diary then this process should feel very familiar. To submit a DVA claim follow the steps below.

Important

When submitting these claims you will need to ensure that you have the correct services configured (including the correct service code). You can learn more about how to set services up here.

  1. Navigate to the invoice for the appointment that you would like to submit the claim for (you can do this by right-clicking the appointment and selecting Edit Invoice).
  2. Open the Insurance drop-down box and select DVA.
  3. Click the Medicare & DVA button that appears to the center-right of the page.
  4. Select either Create DVA Allied Health (for allied health, community nursing, psych, and speech pathology) or Create DVA Paperless (for specialists and GPs) depending on which type of claim you would like to submit.
  5. Most of the information will be automatically filled out for you, such as patient and provider information and referral information (if this was selected on the invoice). You will only need to input a small amount of information such as the treatment location.
  6. Once you have filled out any relevant information simply click Send or Save and Send Later (if you would like to submit multiple claims at once at a later time).

And that’s it! Your claim should go through with a status of Referred if it was successful. If you receive another message you should be able to follow the prompt to troubleshoot and resubmit.


Understanding the DVA fields

When submitting DVA claims you will need to fill out a few fields that you may be unfamiliar with (especially if you are used to claiming through a service such as PRODA). The tables below should help in filling this section out.

Treatment Location

Only applicable for DVA Medical Paperless claims. In the majority of situations, R will be selected, indicating rooms (such as your practice).

Values Constraints Conditions

None
V
= Home Visit

H = Hospital

R = Rooms

Only required for General or Specialist service types.
If the referral override code is set to H then the treatment location code must
This code specifies where the treatment or service was provided.

Claim Certified

This field needs to be set to Y in order to submit the claim. This simply certifies that the services being claimed were in fact provided. 
Values Constraints Conditions
Y = The provider acknowledges certification obligations. This will default to 'Y' if the Claim Certified Date is set. Indicates that the provider has certified the services within the claim have been provided. Must be set to 'Y' to submit the claim.
N = The provider does not acknowledge the certification (Not valid for DVA Allied Health and Community Nursing). - -

Accepted Disability

Set this to Y if the patient is a DVA White Card holder. If you set this to Y then you also have to fill out the Accepted Disability text field below which is used to describe the condition that was treated during the session being claimed.

Values Constraints Conditions
Y = Condition treated relates to a White Card holder If set to 'Y' the Accepted Disability test must be present otherwise value must be 'N'. Indicates whether the services rendered are for a White Card holder and the service is in accordance with the White Card condition.
Not Applicable = Condition does not relate to a White Card holder - -

Accepted Disability Text

Values Constraints Conditions
1-100 Characters
Alphabetical characters [A-Z], numbers (0-9), spaces, and the following special characters : ; , . -
The first character must be alpha or numerical.
No spaces can appear before or after the text.
Must be set when the Accepted Disability is set to 'Y'.

Free text used to provide details regarding the
condition being treated.


Understanding the Service Item fields

When viewing the table of service items, if you click "Show More" you will see several additional fields that can be filled in. This section explains what these fields are used for and when they should be filled. For more information on these fields please see Medicare's website here.

Service Text

Free text used to provide additional information to assist with the assessment of the service.

Values Constraints Conditions
1-100 Characters
Special characters permitted: @ # $
% + = : ; , . -
Must be set when Multiple procedures Override is set to 'Y'.
Must be set when Restrictive Override Code is set.
Must be set when Duplicate Override Code is set.
Use service text to provide the reason for the override.

Account Reference Number

Optional field to record a reference to identify the claim (such as invoice number)

Values Constraints Conditions

Alpha (A-Z) or Numeric (1-9)
1-9 characters long.
No spaces allowed.

Restrictive (override code)

This code is used to allow payment for services where the account provides indication that the service is not restrictive with another service within the same claim or on the patient history.

Values Constraints Conditions
Separate Sites
Not Related (Care Plans for allied health)
Not for Comparison
     -  If set, service text must be set to provide the reason for the override.

Aftercare

Only applicable for DVA Medical Paperless claims. Indicates whether or not the service was performed as part of normal aftercare for the patent (post-operative care and treatment including all attendances until recovery).

Values Constraints Conditions
For aftercare.
Not for aftercare.
     - 

Patients Seen

Only applicable for DVA Medical Paperless claims. List the number of patients seen for the service.

Values Constraints Conditions
1-99 Must be set for group attendance or visits (to home, hospital, or institution) to ensure the correct payment is made.  List the number of patients seen for the service.

Self Deemed

These services do not require a referral.

Values Constraints Conditions
SD = Self Deemed
SS = Substituted Service
Must not be set for General Practitioner service types. 
Must not be set to SS for Pathology service types.
Must not be set when Referral Override Code is set.
A Self Deemed service is a service provided by a consultant physician or specialist as an additional service to a valid request.
A substituted service is a service provided that has replaced the original service requested.

Distance Kms

Indicates travelling distances involved in a home, nursing home, or hospital visit.

Values Constraints Conditions
11-999 Must not be set for Community Nursing service type.
Must be a minimum of 11.
Claim distance travelled for out-of-room visits.
The first 10km is not payable.

Second Device

Only applicable for DVA Allied Health claims. This field identifies the provision of second medical grade footwear service.

Values Constraints Conditions

Y = Yes.
N = No.

This field is only relevant to podiatrists.
Must only be set for Allied service type codes.
This field identifies the provision of second medical grade footwear service.

LSPN Number

Only applicable for DVA Medical Paperless claims. Location Specific Practice Number used for diagnostic and radiation oncology that is specific to an individual location.

Values Constraints Conditions
Numeric ≥ 1 Must not be set for Pathology service types.
Must not be set with number of Patients Seen.
Must not be set with Time Duration.
Only one LSPN Number can be set per claim.

Multiple Procedures (override)

Only applicable to DVA Medical Paperless claims. Indicates whether the multiple services rule should or shouldn't be applied to the services being claimed.

Values Constraints Conditions
Yes = Not multiple  
No = Multiple
Must not be set for Pathology service type.


Used for claiming multiple item codes at once that are not duplicate services.
If set to Yes (i.e. the items are not duplicate services), Service Text must be set to provide the reason for the override.


Duplicate (Services) Override

Indicates whether multiple services performed on the same day, by the same service provider should be treated as separate services.

Values Constraints Conditions
Yes = Not duplicate
No = Duplicate
Must not be set for Pathology service type.

Used for claiming multiple item codes for the dame day that are not duplicate services.
If set to Yes, Medicare Event Time or Service Text must be set to provide the reason for the override.

In Hospital

Indicates whether or not the service(s) rendered to the patient was for treatment provided within a hospital facility.
Values Constraints Conditions
Yes = In Hospital
No = Not in hospital
 The value must be set to Yes if the service was provided in the hospital.

Facility Id

The Commonwealth Hospital Facility Provider Number. A unique identifier of a Registered Hospital or Day Care Facility.

Values Constraints Conditions
 8-digit provider number.      -  Can be set for in-patient hospital claims.

Specimen Collection Point

Only applicable to DVA Medical Paperless claims. Used to identify the site where the pathology specimen was collected.

Values Constraints Conditions
3-4  characters long Alpha (A-Z) or numeric (0-9).  If set, either the referral override code must be set to N, or the Self-Deemed code must be set to SD.

Admission date

Only applicable for DVA Allied Health claims. The date the patient was admitted to hospital.

Values Constraints Conditions
Date Must be set for Community Nursing service type only.
Must not be set after the medical event date (i.e. appointment date being claimed).
For DVA Community Nursing, this is the admission date to the nursing service.

Discharge Date

Only applicable for DVA Allied Health claims. The date the patient was discharged from hospital.

Values Constraints Conditions
Date Must be set for Community Nursing service type only.
Must not be set before the admission date.
Must not be a future date.
Date of discharge from hospital.
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