Claiming for community nursing services
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Definitions and Descriptions
| Definition | Description |
|---|---|
| Add on | An Add on item number cannot be claimed without a Core item number. For each 28 day claim period, Community Nursing providers must identify and claim a Core item number (based on the majority of care delivered) and then choose the relevant Add on item number/s if required. |
| Claim period | Each claim period is 28 days with the date of the first claim period being the date that services to the client commence. A new claim period cannot commence prior to the end of the previous claim period, and must be in sequence with the previous claim period. If a claim with an earlier start date is submitted this will be rejected by Medicare. A new claim will need to be re-submitted with the correct dates. Services are claimed retrospectively and cannot be claimed until after the end of the 28 day claim period. |
| Community Nursing Schedule of Fees | The Community Nursing Schedule of Fees lists the item numbers and associated amount that can be claimed for each 28 day claim period. |
| Item numbers | Community Nursing providers claim for the provision of community nursing services through the use of item numbers outlined in the Community Nursing Schedule of Fees. More than one item number may be claimed in a 28 day claim period. |
| Ready Reckoners | Ready Reckoners assist in determining the 28 day claim period cycles. They are available in pdf and excel format on the Information for DVA approved Community Nursing providers page. |
| Second provider/two providers | Where two providers are required to provide services to a client in a 28 day claim period, there must be no duplication of services. It is expected the providers will liaise with each other to ensure there is no duplication, and that the client’s full clinical needs are met. |
Overview
As a Department of Veterans’ Affairs (DVA) Community Nursing provider, it is your responsibility to check your client’s eligibility before you provide services or claim for services.
DVA funds community nursing services on a 28 day claim period basis. The 28 day claim period includes all the services you deliver to the client during that time.
All claims for community nursing services are processed and paid through Medicare (Services Australia) on behalf of DVA.
Community Nursing providers are allocated a provider number that must be used when claiming for community nursing services. A new provider number may be allocated where there is a change in provider entity or circumstances. The current active provider number must be used when claiming for community nursing services.
There are two ways to claim for community nursing services through Medicare – online or manual.
Back to topOnline claiming
Online claiming is the preferred option and enables the fastest method of payment.
Online claiming is only available using Medicare compliant software, with the list of compliant software and vendors available on the Software developers for Medicare Online Services Australia website.
Further information on online claiming can be found on the DVA education for health professionals Services Australia website.
Back to topManual claiming
Manual claiming requires Community Nursing providers to complete the below listed DVA forms and then submit these via post to Medicare. The forms cannot be submitted via email.
In addition to these two forms, Community Nursing providers who submit manual claims must also submit the Minimum Data Set (MDS) Collection Tool.
Once completed, the tool must be emailed to mds [at] dva.gov.au (mds[at]dva[dot]gov[dot]au).
Further information on MDS can be found in the Notes for Community Nursing Providers. Information on the MDS Collection Tool can be found in the MDS Quick Reference Guide.
Back to topTimeframes for claiming
As per the Notes for Community Nursing Providers, claims for payment for community nursing services, regardless of the claiming method used, must be lodged with Medicare for processing within six months of the first day of the 28 day claim period.
In addition, the Health Insurance Act 1973, section 20B(2)(b), states that a Medicare claim must be lodged with Medicare within two years of the date of service.
Late lodgements due to poor record keeping, inadequate staffing, resources or training, or any issues with record keeping software will not be accepted after the two year timeframe.
Back to topLate claims
As advised on the provider claims page, DVA can accept claims up to two years from the date of service.
Claims greater than two years from the date of service can only be considered if the provider can:
- show us that if we do not assess your claim, you may suffer financial hardship
- provide us with documents that prove you may suffer financial hardship.
If you are seeking to lodge a late claim with DVA, please call 1300 550 017.
Back to topQuick reference guide
A quick reference guide has been developed to provide key information, further definitions and contact numbers. You can use this guide to assist in determining the correct item number/s to claim.
You can download a copy of the Quick reference guide (PDF 1.3 MB).
Back to topEnquiries
For all general community nursing claiming enquiries (not including rejected claims), contact DVA Provider Enquiries on 1800 550 457.
For claims that have been rejected in Medicare, contact Medicare on 1300 550 017 (option 2).
For all other community nursing claiming enquiries (e.g. item codes, additional travel) contact the Community Nursing Program team at nursing [at] dva.gov.au (nursing[at]dva[dot]gov[dot]au).
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