How do I manage MoH claims for under 18s?
To manage all claims for MoH patients:
Open the claim management tool by clicking the shield icon in the left-hand toolbar.
Use the tabs at the top to switch between treatment reports and prior approvals.
At the top you will also see the total pending amount.
When you have completed a treatment plan, the individual treatment report (ITR) will automatically be generated and will appear in the claim management tool. This is what you will need to send to MoH in order to get paid.
The treatment plan will be listed with a treatment plan ID, the patient's name, fee schedule and practitioner, the fee requested, and when the treatment plan was completed. If the ITR has a prior approval, this will also be displayed.
The 'Status' column indicates the progress of the plan's claim - this field updates automatically when a claim is created, and then all subsequent updates must be done manually. You can also add a status comment for certain statuses.
Use the search bar and filters along the top to adjust/limit your view.
Once a claim is created, you will be able to see the claim reference number, the fee received, the claim summary, and a link to the ITR.
How do I create a claim summary for unsubmitted treatment plans?
To generate claim summaries for all unsubmitted treatment plans which are ready to submit:
Either, select manually which plans you wish to submit, using the tickbox next to each claim - then click 'Generate claims'. You must only select rows/ITRs that have no claims created against them or else the button will be greyed out
Or, click 'Generate claims' without selecting specific plans - it will automatically include ITRs with claims not yet created in your list.
You will be prompted with confirmation - this will highlight how many treatment plans there are to claim, and how many claims are ready to submit.
You can select 'Create only' or 'Create & Submit'.
Clicking 'Create only' will apply a claim reference to each entry - any claims within the same bundle will have the same claim reference.
You can also click the number in the 'Claim summary' column to view and download the claim summary. Each PDF should automatically download after you have created the claim summary.
When a claim has been submitted, it will show in the patient record under the 'Account' tab, with the amount due.
Clicking 'Create & Submit' will do the same thing as 'Create only', and in addition it will take you to the email preview window where you can submit claims.
🚨 Important: If you selected valid unclaimed ITRs when clicking 'Generate claims', clicking 'Create & Submit' will only submit claims you have just generated. If you did not select valid unclaimed ITRs when clicking 'Generate claims', it will try to send all those you just created plus all other existing claims which are ready to be sent.
When a claim has been paid, update the 'Status' column for that claim. You will be prompted to confirm the amount paid (it will also display how much was requested, so you can see easily if there's any discrepancy).
When you mark the claim as paid, the patient's account will update to reflect that the amount due has now been paid.
💡 Top tip: Use the 'Status' column to update the claim's progress, so you and your team can keep track.