Guide to Completing the DVA Claiming Voucher … · Web viewDVA Community Nursing Program - Guide to completing the claiming voucher spreadsheet -1 March 2010 DVA Community Nursing

.: Community Nursing

Program

Claiming Voucher Spreadsheet and Claim

Header Completion Guide

1 March 2010

Table of Contents

1 CLAIMING METHODS ............................................................................................................... .1

1.1 Completing the claiming voucher spreadsheet (voucher spreadsheet)..........................1

1.2 Purpose .............................................................................................................................. ....1

1.3 How to use this document ................................................................................................... .1

1.4 Completing voucher spreadsheet........................................................................................1

2 ACCESSING THE VOUCHER SPREADSHEET ........................................................................2

2.1 Downloading the voucher spreadsheet ..............................................................................2

3 COMPLETING A CLAIMING VOUCHER SPREADSHEET .......................................................4

3.1 Completing the claiming voucher spreadsheet contd.......................................................53.1.1 Completing the Provider Details on the voucher spreadsheet............................................63.1.2 Completing the Claim Details ..............................................................................................63.1.3 Sample of the completed claiming voucher spreadsheet ...................................................9

4 COMPLETING THE CLAIM FOR TREATMENT SERVICES (CLAIM HEADER D1217) ........10

4.1 Example of the claim header - D1217 ................................................................................10

4.2 Submission of completed voucher spreadsheet for payment........................................11

4.3 Example of the completed claim header – D1217 ............................................................12

1 March 2010

1 Claiming MethodsDVA-contracted community nursing providers can claim for payment by either using a paper based claiming method or an electronic method. This guide only discusses the paper based claiming method using the Claiming Voucher Spreadsheet.The claiming method is made up of 2 parts:

1. Claiming Voucher Spreadsheet (voucher spreadsheet)2. Claim for Treatment Services (claim header)

1.1 Completing the claiming voucher spreadsheet

(voucher spreadsheet)This document outlines the procedure to be followed when completing the voucher spreadsheet byCommunity Nursing Provider.Read this document in conjunction with:

• The Guidelines for the provision of community nursing services, the Guidelines are available through the DVA website and to access the Guidelines either use the following link: http://www.dva.gov.au/service_providers / community_nursing/Pages / Guidelines.a s px OR follow the menu path www . dva.gov.au > Service Providers > Community Nursing > Information for DVA Community Nursing Providers > Community Nursing Guidelines

• Paper-Based Community Nursing Claiming documents, to access the documents use the following link: http : //www.dva.gov.au/service_p r oviders/commun i ty_nursing/C l aimi n g_ v oucher_sp r e a dsheet/Page s / Claim i ng_vouchers.aspx OR follow the menu path www.dva.gov.au > Service Providers > Community Nursing > Information for DVA Community Nursing Providers > Claiming Vouchers

1.2 PurposeTo guide the user through the claiming procedure and introduce them to the terms and formats used to complete the voucher spreadsheet.

1.3 How to use this documentThe prospective users of this user guide will be:

• DVA – contracted community nursing providers using the voucher spreadsheet provided byDVA

• DVA – contracted community nursing providers using a voucher spreadsheet developed in their practice management software

u DVA – contracted community nursing providers that develop a voucher spreadsheet in their own practice management software must follow the format instructions provided by DVA in the voucher spreadsheet.

1.4 Completing voucher spreadsheetProcess of completing the claiming voucher spreadsheet in this document has been broken into three segments.

1. Accessing and downloading a claiming voucher spreadsheet2. Completing a claiming voucher spreadsheet3. Completing a claim for treatment services (claim header D1217)

DVA Community Nursing Program - Guide to completing the claiming voucher spreadsheet - 1

DVA Community Nursing Program - Guide to completing the claiming voucher spreadsheet -1 March 2010

2 Accessing the voucher spreadsheetMicrosoft Excel format is the preferred option to complete and submit the voucher spreadsheet. The voucher spreadsheet, including the format instructions, is available online and the user is required to download the voucher spreadsheet through the DVA website.

2.1 Downloading the voucher spreadsheetThis part of the guide will take you through a step by step method to download the claiming voucher spreadsheet and format instructions from the Internet

Step 1.Open the Internet Web browser and key in http://www.dva.gov.au to display the DVA home page

¡ Department of Veterans’ Affairs home page will be displayed.


Step 2.

Click on the link > Service providers > Community Nursing to proceed to theInformation for Community Nursing Providers page

¡ Select Claiming Vouchers from the Information for Community Nursing Providers page

Click on the Claiming voucher spreadsheet link to proceed

¡ A File Download dialogue box similar to this will be displayed

Excel spreadsheet

Click on the Save button to proceed

¡ A Save as dialogue box will be displayed


Save in: Select or create an appropriately named folderFile name: Save as type:

Rename the file from ‘claiming_spreadsheet’ as appropriateMicrosoft Excel Worksheet

Click on the Save button to proceed

3 Completing a claiming voucher spreadsheetOpen the saved Microsoft Excel Worksheet – Claiming voucher spreadsheet

¡ The Claiming voucher spreadsheet will be displayed


The Claiming voucher spreadsheet consists of three worksheets.

1. Instructions on how to useThis page describes how to complete the claiming voucher spreadsheet and handy tips.

2. Format InstructionsThis page outlines the formats to be used whilst completing the claiming voucher spreadsheet.

u The format instructions need to be used if creating a voucher spreadsheet in practice management softwareDo not enter more than 14 claims on one page

Do not enter any data in the grey fields

3. Claiming spreadsheetThe claiming information is entered in this spreadsheet.

3.1 Completing the claiming voucher spreadsheet step-by-step

This part of the user guide will take you via a step-by-step method to complete the claiming voucher spreadsheet.In the claiming voucher spreadsheet each numbered line represents one community nursing 28-day claim period for an entitled person.If you are claiming for more than one 28-day claim period for an entitled person multiple lines will need to be completed.

The voucher spreadsheet is divided into two sections

1. Provider details

2. Claim details


u Details are mandatory and all fields must be entered in a correct format The field provider declaration is included on the service voucher but not on the claiming voucher spreadsheetAll other information on the service voucher is included on the claiming voucher spreadsheet

Step 13.1.1 Completing the Provider Details on the claiming

voucher spreadsheetProvider Name: Enter DVA-contracted community nursing provider’s Legal

Entity nameProvider Number: Enter provider numberClaim for Treatment Services No. (D1217):

Enter D1217 number (Step 3: Section 4)

Step 23.1.2 Completing the claim details

Column Details Explanation and ExamplesNo. Line number for each claim

periodSerial number is automatically populated by default.

• Do not make any change.DVA FILE NO Enter DVA File Number of

the Entitled PersonDVA File Numbers are alphanumeric. Examples:

– Veteran in own right - NX001235, NSWP12334, orQX123456 (8 digits)

– Spouse - NX001235A (9 digits)SURNAME Enter surname of the

Entitled PersonPreferred format to enter the Entitled Person’s surname is upper case.Example: BLOGGS

FIRST NAME Enter first name of theEntitled Person

Preferred format to enter the Entitled Person’s first name is upper case.Example: JOE

DOB Enter date of birth of theEntitled Person

Enter birth date in DD/MM/YYYY format only. Example: 16/11/1927

CLAIM PERIOD

Enter the date on which the claim periodcommenced (Claim StartDate)

Claim period must be at least 28 days since the ClaimStart Date of the last claim.Claim date must be entered in DD/MM/YYYY format. Example: 16/04/2010


ITEM NO Enter the item number for the delivered services

This field is mandatory and cannot be left blank (do not enter text such as ‘No Visits’)Item numbers identify the services delivered and consist of4 alphanumeric characters. First two characters are alpha and last two characters are numeric.Examples: NA01, NY06, NZ13, NO59 etc.Refer to the Community Nursing Schedule of Item Numbers and Fees (Schedule of Fees). The Schedule of Fees is available on the DVA Community Nursing website:http://www.dva.gov.au/service_providers / communit y _nursing / Pages/index.a s px

REF PROVIDER

Enter referring provider number as shown on thereferral (only for the first claim of the 12 monthreferral period)

Referring provider number is the provider number of an authorised referral source (ie. LMO, GP, Hospital Discharge Planner).The referring provider number is entered ONLY for the first28-day claim period of an entitled person’s 12 month referral period.

REF DATE Enter the referral date The referral date must be entered for the first 28-day claim for payment.The referral date must be before the commencement of service or the admission date – the first face-to-face visit).The referral date is the date when the referral was provided for an entitled person’s episode of care. If a verbal referral was provided before a written referral, the date of the verbal referral should be used.This field must be completed on the claiming voucher spreadsheet ONLY for the first 28-day claim period of an entitled person’s episode of care.Referral date must be entered in DD/MM/YYYY format. Example: 14/04/2010

ADMISS DATE(admissiondate)

Enter entitled person’s admission date

The admission date is the date when the entitled person is first admitted to Community Nursing Services (ie. the first face-to-face visit).This field must be completed on the claiming voucher spreadsheet ONLY for the first 28-day claim period of an entitled person’s episode of care.Admission date must be entered in DD/MM/YYYY format. Example: 16/04/2010

DISC DATE (dischargedate)

Enter entitled person’s discharge date

Discharge date (or date of death) is when the entitled person was discharged from Community Nursing Services (ie. the last day of service provided to the veteran or the date of death)Discharge date must be entered in DD/MM/YYYY format. Example: 10/07/2010This field must be completed on the service voucher for the last 28-day claim period. If a claim has already been made, then no further action is required.


WHITE CARD (eligibility checked)

Enter ‘Y’ if the entitled person is a White Card holder who is eligible to receive CN services

Some White Card holders are entitled to Community Nursing Services, however eligibility MUST be checked with DVA location office prior to the commencement of the services.Recording a ‘Y’ in this field indicates that you have

completed this eligibility check for the White Card holder.Note: All Gold Card holders are entitled to CommunityNursing Services.

u You must print the completed claiming voucher spreadsheet as the claiming voucher spreadsheet cannot be submitted electronically

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DVA Community Nursing Progrcon- Guide to completing the claiming voucher spreadsheet-1 March 2010

3.1.3 Example of a completed claiming voucher spreadsheet

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ouider Name: Claim for Treatment Services No.:2 Provider Humber: (01217)

WHITE

CLAIMCARD

(-e ligiblit,3 No. DVAFILENO SURNAME FIRST NAME 008 PERIOD ITEM NO PROVIDER REF DATE ADMISSDATE DISC DATE c•-ec•cd)

•5 1 QX123456 VETERAN JOE 0110211922 - r 1201o NY02 0123456Y 01/03/2010 02/03/201067 2 QX123456 VETERAN JOE 0110211922 - r 1201o NC138

9 3 NSS12345 CITIZEN JOHN 3/04/1926 - r 1201o NZ0 4 y10

11 4 VX123456A WIDOW MARY 28107/1932 - r 1201o NY101213 5 QX123456 BLOGGS JOE 04/10/1926 - r 1201o NY02 16104/201014

15 6 QX123456 BLOGGS JOE 04/10/1926 - r 1201o NT5 81617 7 QX123456 BLOGGS JOE 04/10/1926 - r 1201o N80118

19 8 TKM12345A WIDOWS NELLIE 19/0B/1920 - r 1201o N05620

21 9 WSM12345 MEMBER GEO 2810 4/1965 - r 1201o NY01 0654321A 1110512010 1510512010y

2223 102425 1126

27 122829 133031 1432

uider Name: 0 Claim for Treatment Services No.: 0(01217)

35 Provider Humber: 0I WHITE

CARD(eligiblit'

36 No. DVAFILENO SURNAME FIRST NAME 008 PERIOD ITEM NO PROVIDER REF DATE ADMISS DATE DISC DATE c•-ec•cd)

37

38 153940 1641

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• •'.I\ Instructions on how to use L Format Instructions Claimina Soreadsheet J.!..l


Step 3

4 Completing the Claim for Treatment Services

(claim header D1217)

The claim header must be completed and attached to the claiming voucher spreadsheet sent toMedicare Australia.The claim header is divided into three sections

1. Provider details2. Claims details3. Provider declaration

Copies of the voucher spreadsheet and the claim header can be requested:

– online at http://www.dva.gov.au/servi c e_providers/Pa g es/Forms.aspx

– by telephone on 1800 155 355

– by fax on 1800 671 670

– by mail to:

DVA Distributionc/- Moore ADS Pty LtdBuilding 239 Ashley StWest Footscray VIC 3012

4.1 Example of the claim header - D1217

Claims details

Details of ServiceProvider Provider declaration


Details of Service Provider

Name: Enter your Legal Entity nameAddress: Enter your address detailsProvider Number: Enter your provider number

Payee’s Provider Number:

Claim for Treatment Services

Enter only if the payment is to be made to another provider. (The field Payee’s provider number should only be filled in ifthe DVA-contracted community nursing provider’s paymentwill be made to another provider number)

Date of Claim: Enter the date of claim **/**/**Claim number: AREADY PRINTED ON FORMNumber of Vouchers:

Total Amount Claimed:

Provider Declaration

Signature of the Provider:

Enter the number of service vouchers (number of claims)contained in the voucher spreadsheetEnter the total claim amount(The total claim amount must be exclusive of GST. GST will be added to each service voucher by Medicare Australia when the service voucher is processed for payment)

Sign and date the declaration(Date of the signature must be same as the Date of Claim)

u Always use a ballpoint pen to complete the headerWhen completing the number of vouchers, the total number of vouchers attached to a claim header using the voucher spreadsheet cannot exceed forty (40) entries

4.2 Submission of completed claiming voucherspreadsheet for payment

Submit the completed claiming voucher spreadsheet to the following address:

Medicare AustraliaGPO Box 964ADELAIDE SA 5001


4.3 Example of a completed claim header – D1217

u Examples used in this document do not contain real data and must be used as a reference material only.

u Please use this document in conjunction with the ‘Guidelines for the provision of community nursing services – effective 1 March 2010’

Documents

Guide to Completing the DVA Claiming Voucher … · Web viewDVA Community Nursing Program - Guide to completing the claiming voucher spreadsheet -1 March 2010 DVA Community Nursing