Claims processing

Claims processing flows

DVA claims- also called invoices - will have both synchronous and asynchronous outcomes. Approximately 75% of claims are adjudicated in real-time with a synchronous response provided within 15 seconds. The remainder of claims are asynchronous, with adjudication responses ranging from hours to typically two business days from submission. Partners will need to accommodate for asynchronous responses which can be pushed from Tyro Health via webhooks or periodically polled by partners via an invoice status API.

Once a claim is submitted, the status can change as follows:

Outstanding : claim is under review by DVA
Approved : claim is approved for settlement
Declined : claim was declined and will not be paid
Cancelled : claim was canceled by the provider prior to settlement
Completed : approved claim paid/settled to provider

If multiple service items are claimed and one item is rejected the whole invoice will be marked as Declined.

Claim structure

To issue a successful claim, the following details are required in each invoice:

Provider, profession and location : Usually set with a single provider number attribute. These details must be registered with Tyro Health in advance of a claim. Only one provider can claim per invoice. Optional attributes can include is in hospital, lsp Number, facility Id, treatment location (conditional),benefit payee provider number and benefit payee provider full name.
Patient Details: including first and last name, date of birth,veteran file number,accepted disability indicator. Optional attributes can include address and patient second initial.
Service items: including date of service, item number and fees are required.

DVA does not currently support attachments. If an attachment is required to support a claim those details must be sent directly to DVA by the provider.

Supported Providers and Patients

Professions and geographies

DVA currently support electronic claims from:

Aboriginal and Torres Strait Islander Health Practice
Acupuncture
Ambulance
Audiology
Chinese Medicine
Chiropractic
Counselling
Dental
Diagnostic Imaging
Dietetics
Exercise Physiology
General Health Equipment
General Practice
Genetic Counselling
Home Care service and Aids
Hospital
Mental Health
Myotherapy
Naturopathy
Nursing and Midwifery
Occupational Therapy
Optometry
Orthoptics
Orthotics/Prosthetics
Osteopathy
Pathology
Perfusion (Medical)
Pharmacy
Physiotherapy
Podiatry
Psychology
Radiology
Remedial Massage
Social Work
Specialist Physician
Specialist Treatment centres
Speech Pathology

DVA is a nationwide insurance scheme with eligible patients in all states and territories. Providers in all states and territories are welcomed to join and enable DVA claiming.

Providers must first register with Tyro Health prior to submitting a DVA claim. This registration process is self-service and can be completed within a few minutes. If providers deliver services from multiple locations or businesses, each unique provider number must be registered. Details on provider registration and Medicare activation is provided at:https://help.medipass.com.au/en/articles/4064976-activating-medicare-and-dva-claiming-in-medipass

Patients

Any eligible DVA member with a valid Veteran file number can use this service.

For more details on who is eligible for DVA please see: https://www.dva.gov.au/financial-support/income-support/eligibility-benefits-and-payments

Patients can have more than one active claim with DVA at the same time.

Eligibility checks and quotes

The DVA integration does not currently support patient quotes for services to be rendered. Tyro Health plans to introduce these capabilities in a future update. Tyro Health provides a verification service that can be used to check DVA patient details and Concession eligibility in advance of a claim. This resource provides a more seamless claiming experience for your patients on day of service and can be used to determine potential to claim benefits.

The service will verify multiple attributes of a DVA account, including:

First name
Last name
Date of birth
Medicare card number
Medicare individual reference
Medicare account status
Sex
Concession status

For claiming and account verification, Providers need to be registered with DVA and hold an active Medicare issued provider number at each servicing practice to be enabled for online claiming. Providers must also lodge an application form, even if previously registered for online claiming. This application covers both Medicare and DVA claiming registration. Tyro Health Online provides an assisted account setup and activation process to complete and lodge these forms: https://help.medipass.com.au/en/articles/3193875-signing-up-for-medipass

Processing and Settlement periods and Payment of invoices

Providers can lodge DVA claims 24/7.

Most claims are processed instantly by DVA using their straight-through adjudication method. Those claims will return an approved or declined status within 15 seconds and the SDK will return that status via a callback.

Claims that cannot be instantly processed will require manual review by DVA case managers. Other claims which contain miscellaneous, general catch-all and special items will also go into under review status for manual review when submitted.

Invoices that are placed Under Review at the time of submission will be handled manually by a DVA claims manager. This typically occurs during business hours Monday-Friday.

Once the provider's invoice has been approved by DVA within Tyro Health, funds will be deposited to your nominated bank account the following business day by Tyro Health.

Reporting, statements and receipts

Tyro Health automatically generates patient reports, statements and receipts on behalf of the partner/providers. These reports and receipts can be obtained from the Tyro Health Online provider portal or via API calls.

Invoices are automatically generated by Tyro Health Online for each employee and the treatments delivered. These invoices are directly sent to DVA 's for approval. Providers can print copies of the invoice from the Tyro Health Online provider portal or invoice details can be generated by a partner PMS for print or email to patients.

Remittance reports

Remittance reports are available on the Connect Portal when the payment has been made. Remittance reports will include all payments to a provider for the given settlement period which can include payments for other funding sources such as icare, DVA and payment cards.