HCP Claiming Process: Step-by-Step Guide
Claiming is the process of submitting requests for payment or reimbursement to funding bodies, such as Services Australia, for care and services that have been delivered to clients. It ensures that service providers receive the appropriate funding based on the services rendered and documented during the billing process.
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I. The Claiming Process
The image provides an overview of the billing and claiming process, with pink indicating the billing process and violet indicating the claiming process. Once the billing process is complete, follow the steps outlined in this topic to submit claims for payment.
1. Generate the claim export for the same billing period
After completing the billing process, navigate to Settings > Exports > Generate Export.
On the Generate Export page, retain all parameters the same as those used for the billing process. This helps ensure consistency between your billing and claim files.
Change the Select Export Type field to HCP Claim File Export.
Reselect the Outlet ID to prevent errors, as this field may have been reset.
2. Run the claim for the corresponding billing period
Review all settings. If you verify that all settings are correct, click Generate Export.
3. Export the claim as a CSV file
The file includes the following columns: Claim Year-Month, Care Recipient ID, Family Name, Given Name, and Amount.
4. Upload the CSV claim file to Services Australia
Upload the verified claim export file to Services Australia. You may have generated multiple versions, but only one should be submitted.
5. Export Completed
The claim export process is complete. While you wait for the payment statement summary from Services Australia, perform the following steps.
II. Process After Claim Submission
1. Locate the Uploaded Claim File and Export ID
Go to Settings.
Click Exports.
Click View Billing Exports History.
Find the claim file you uploaded to Services Australia.
Click the downward arrow to the left of the corresponding file.
Take note of the Export ID for your reference.
2. Mark the Claim File as Final in the CareVision Portal
In the left menu bar, click Actions.
Select Balances.
In the Select a Period to View field, choose the relevant month and year for your claim.
In the upper left, click HCP Claim File Exports History.
Find the Export ID you previously noted.
Under the Actions column, click Mark as Final next to the corresponding Export ID.
You can select Mark as Final only if the file is ready for finalization.
Alternatively, you can select Mark as Final and Re-Calculate if you need the system to update calculations before finalizing.
3. Automatic Reconciliation
CareVision will automatically reconcile the payment statement with your claim file.
The system will calculate the expected funding based on the client’s funding sources, previous balance, claim amount, income tested fees, and subsidy due.
4. Upload Payment Statement Summary in CareVision
Once you receive the payment statement summary from Services Australia, log in to CareVision.
In the left menu bar, click Actions.
Select Balances.
In the Select a Period to View field, choose the relevant month and year for your claim.
Click Upload Balances.
Set the Period field to the relevant claiming month.
Set the Budget or Funding Type Reference to HCP.
Set the Balance Source field to Services Australia Held Balances.
Click Add File to attach the file payment statement summary from Services Australia.
5. Investigate Variances
Review any variances highlighted in red after uploading the payment statement summary.
Resolve all variances before sending out statements. If a variance cannot be resolved, it will appear as an extra line on the client statement and may require explanation.
Common Reasons for Variances | |
Issue | Solution |
Client funding level changed mid-period and not updated in CareVision | Update the client’s funding sources in CareVision before issuing statements. |
Unexpected income tested fees or funding deductions | Review and adjust deductions in CareVision as needed. |
Manual modifications made to the claim file | Avoid manual changes. Use the original exported file to prevent discrepancies. |
Actual claim amount differs from expected | Investigate the source of the difference and correct data in CareVision if necessary. |
6. Final Check Before Sending Statements
Ensure there are no outstanding variances (no red dots on the dashboard).
Once all issues are resolved, you can proceed to send out client statements.
This document provides a step-by-step guide to the claiming process in CareVision to support you during the claiming period. CareVision assists you throughout the process and provides tools such as automated validation and reconciliation to help your finance team streamline procedures, making it easier to submit claims to funding bodies like Services Australia for client care and services.
For more information about the claiming process, contact the CareVision support team.
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