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      2. Gensolve Enterprise Manager
      3. Medicare

      Medicare Online Patient Claims Resulting in a Pendable Claim Status

      Issue

      You have processed a Medicare Online Patient Claim and have received a message from Medicare stating that the Claim is in a Pendable state.

      Reason

      Any Patient Claim that receives the status of Pendable indicates the Claim, as it stands will need to be reviewed by a Medicare Operator.  This may be due to the unusual or complicated nature of the Claim.

      Whilst the Claim is still in the Pendable state, it is neither Rejected or Assessed.  You need to either proceed, and change it's status to Pended (reviewed prior to re-submitting) or Cancel the Claim.

      Important: You have 60 minutes to resubmit the Pendable Claim, after that time if it is not resubmitted, it will be marked as Expired. A new claim can be submitted if required.

      Solution

      To Proceed the Claim to be Reviewed by an Operator and Mark the Claim as Pended:

      1. After processing a claim you have received a message and a claim status of Pendable.
      2. The notification from Medicare will include a Code and a description of why the code has been marked as Pendable.
      3. To proceed and have the Claim processed by a Medicare Operator, click Yes.
      4. You will be returned to the Claim screen.  You can now review the Claim, and make any adjustments if applicable. Click Submit Medicare Claim once you have completed your review. You have 60 minutes to resubmit the Claim.
      5. The claim will be marked as Pended. Click OK
      6. 2. You can now View/Print the Claim Receipt.  We would recommend that the Claim Receipt is  provided to the client at this point and they be notified of it's Pended nature.  
      7. 3. The Statement of Claim and Benefit will show the Pended Claim status as per below:
      8. When returned to the Claim Screen click Finished.

      Note: Medicare will not provide you with any indication that the claim has been Assessed (paid) to the client, or Rejected.  Medicare will contact the client directly.  If the Client in the interim has any queries or concerns, they will need to contact Medicare. As the claim is being reviewed by an Operator the payment if any may be delayed to the client.

      To Cancel the Claim

      1. At the Pendable Claim screen notification click No.
      2. You will be returned to the Claim screen.  Click No when presented with the View/Print Receipt notification as no claim has been submitted.
      3. On the Claim screen click on Finished