Education guide - Claiming for the right patient

Get it right every time by choosing the right patient when lodging Medicare claims.

Digital claiming is a convenient way for health professionals to claim Medicare benefits online. As a health professional, it offers you an alternative to paper based claiming.

It also allows you to lodge Medicare claims on behalf of claimants at your practice. This means faster and more efficient payments.

Claimant and patient – what’s the difference

It’s important you choose the right patient when lodging digital claims. To clarify:

  • ‘patient’ is the person who received the service
  • ‘claimant’ is the person who incurs the medical expense for the service.

This ensures the correct patient history is recorded and the Medicare benefit is paid to the correct person.

When information is lodged incorrectly, it can cause delays for related claims in the future.

You may then need to adjust affected claiming histories to fix these issues, which further delays payments.

Case Study

Lodging a patient claim for a child under the age of 14.

Hayley’s 10. She’s unwell and attends her family doctor at your practice for a general consultation and check-up. Hayley’s mother Jill accompanies her.

Jill’s responsible for the settlement of Hayley’s account.

Your claim should identify Hayley as the ‘patient’ and Hayley’s mother Jill as the ‘claimant’.

This ensures the Medicare benefit goes to Jill, the correct recipient with the registered bank account.

The service should then be attributed to Hayley, the patient.

You can learn more about Medicare billing and claiming - basics in our suite of Health Professional Education resources.

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Page last updated: 10 December 2021