Patient Verification Methods for Electronic Claiming
Online Patient Verification (OPV) checks a patient's Medicare card. Three further online verifications sit alongside it on the patient record: PVF for a private health fund membership, OVV for DVA entitlement, and OEC for eligibility ahead of a hospital admission. All four use the same Medicare Web Services integration to retrieve real-time confirmations.
Online Eligibility Check (OEC) functionality requires additional configuration. Please contact HealthTrack Support if you are interested in enabling this feature.
What each verification checks
| Verification | What it checks | What the patient record needs |
|---|---|---|
| OPV Online Patient Verification | Medicare card details, and whether the patient is eligible for online billing | Medicare card number and expiry date |
| PVF Patient Verification with Fund | Private health fund membership with the fund | Fund, membership number and expiry date, plus a provider number chosen when you run the check |
| OVV Online Veteran Verification | DVA file number and entitlement with the Department of Veterans' Affairs | DVA file number and DVA card type |
| OEC Online Eligibility Check | A patient's eligibility and benefit position for a hospital admission | Both a Medicare card number and a health fund membership number |
Where to Perform Verifications
The OPV, PVF, OVV and OEC buttons sit together on the patient's Demographic tab, beside the card fields each one checks. Open the patient record, then go to the Demographic tab.
If a patient's details have not been checked recently, users may be prompted to perform a check when opening an invoice for the patient.
You can additionally verify a patient's details from an invoice by using the Online Verification button in the top right of the invoice and choosing which check to perform: Medicare (OPV), DVA (OVV), or Healthfund (PVF).
An OEC can also be performed through an admission using the Eligibility button, as well as through Hospital > Eligibility Checks. The Eligibility Checks screen lists the OECs for all patients, where they can be resubmitted or printed if needed.
Performing Each Check
PVF (Health Fund)
- Open the patient record and go to the Demographic tab.
- Confirm that the health fund, membership number, and unique patient identifier (UPI) are recorded.
- Click PVF.
- Select the provider and provider number/location the check is to be made against.
- The result screen displays the response from the fund to confirm whether the patient is known to the fund.
If the patient has different names recorded with Medicare and their Health Fund (e.g. a maiden name), use the Name Aliases button on the Demographic tab to record the name used for their Health Fund. The PVF can check any aliases automatically to confirm whether the fund recognises the patient under these names.
Health Fund Changes
As the PVF is performed in real-time, you may encounter issues with verifying a patient's health fund retrospectively, such as if they have changed or cancelled their coverage. If you need to check a patient's fund details at a specific point in time:
- Open the patient record and go to the Demographic tab.
- Select Edit.
- At the top of the screen, change the Status to Deceased.
- Enter a date, such as one day after the service you need to claim for.
- Select Save.
- Select PVF and perform the check as detailed above.
After you have successfully verified the patient's health fund details and submitted any outstanding claims, you can edit the record to remove the date of death and return the patient to the Active status.
By temporarily marking the patient as deceased, you can perform the PVF at a nominated date, rather than today's date. Information about the patient's status (i.e. active, deceased) is not included or verified in the PVF.
OVV (Department of Veterans' Affairs)
- Open the patient record and go to the Demographic tab.
- Confirm the DVA number and DVA card type fields are populated.
- Click OVV.
- The result screen displays the response from DVA.
DVA entitlement is conveyed by the card colour, held in the DVA card type field. There is no separate disability or entitlement field on the patient record.
OEC (Online Eligibility Check)
Run an OEC before an admission, so the fund's benefit position and any excess or co-payment are known before the patient arrives.
- Open the patient record and go to the Demographic tab.
- Confirm both the Medicare card number and/or the health fund membership details are populated.
- Click OEC.
- Select New.
- Enter the details, including the claim type, location, admission and discharge dates, and presenting illness.
- Select the Submit Check button.
A PDF will be generated on screen to advise the patient's eligibility. This can be printed and provided to the patient as necessary.
Eligibility Check History
- Navigate to Hospital > Eligibility Checks.
- Specify filters at the top of the screen, such as a particular location, health fund, or date range.
From the Eligibility Check History screen, you can double-click on a patient to open the OEC window, where an eligibility check can be resubmitted or reprinted.
There are Actions on the right-hand side of the screen, allowing users to open the OEC window, print a response, and go to the patient's record.
Unable to Access Verifications
The buttons to perform each type of verification may be unavailable (e.g. "greyed out") or missing in the following situations:
- The required fields are empty or do not pass algorithm checks.
- HealthTrack has not been set up for Medicare Online and/or OEC functionality.
- The Demographic screen is in Edit mode.
- A user is accessing a Test System.
Reviewing Last Successful Verification
HealthTrack records the date of the last successful verification of each type against the patient.
- By clicking the ? button from the patient banner at the top of the screen (next to the Medicare number), the audit details will display when the last verifications were performed, and which user performed it.
- When you hover your mouse over each button, a tooltip will be displayed to advise how many days since the last check.
- If the button displays a yellow exclamation warning, this indicates that the type of check has never been performed successfully, or that at least 6 months have passed since the last check.