Payment and exception reports
Once a claim is accessed two files are sent back to eClaims. The exception statement details the assessment of claim and lists the amount that will be paid for each item claimed. The payment file lists a summary of the amount transferred to the bank account.
These reports can be printed when they are received if required but this isn’t necessary as the details are automatically added to the batch in the batch handler.
For more information on receiving files from Medicare or Eclipse please refer to Receiving Files Online.
Exception Statement
Exception Statement displays the claim assessment and any rejections on each item within the batch. All information displayed on this report is added to the invoice in the batch handler automatically so there is no need to print this report unless you want to keep a record of the adjustments and rejections after the batch is archived.
If the benefit paid is different to the amount claimed a reason code will be displayed on the report for each item in the batch.
Benef Assg is the amount claimed.
Benef Paid is the amount assessed to be paid.
Exp is the reason given for a different amount being paid than was claimed and at the bottom of the page is a description of the reason.
The first part of the report lists a summary of  the total claim. The Claim ID is displayed as a batch number in the batch handler. In this example the batch number is F0091.
The second part of the report details the assessment of each individual item within the claim.
The details from the report are automatically added to the batch handler as displayed below. If the amount received is red it means an exception has been applied to one or more items within the batch.
Open the batch to see the items that have been assessed at a different amount to the amount claimed.
Click on an invoice to see the assessment on each individual item. If an exception code is applied to an item the description will be displayed at the bottom of the screen.
The Exception Statements can be several pages long. The information displayed in this report is also visible in the batch handler to assist in reconciling payment and identifying payment rejection or cases where a different amount is paid. It is not obligatory to print these reports.
Payment File
HIC Online EFT Payment File details all payments made to the doctor. This report gives information at a batch level listing the account where payment was made, the name of the doctor providing the service, batch number in eClaims, date of transmission and the amount paid.
The date received and run number fields are automatically added to the batch handler from the payment file.
