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Auto-submit Medicare claims on appointment completion

Certification in progress

Praxi is completing Services Australia conformance testing for Medicare Online Claiming. Production claiming becomes available once Services Australia grants the Notice of Integration (NOI). This page describes how the workflow operates so your practice can prepare; we will update it when certification completes.

Halaxy and Zanda (formerly Power Diary) call this "automatic rebate processing"; in Praxi it's the Auto-Submit on Completion flow. When enabled, the moment a practitioner marks an appointment complete, Praxi:

  1. Finds (or waits a moment for) the auto-generated invoice for the appointment.
  2. Confirms every precondition (patient verified within 24 h, DB4 consent on file, MBS item assigned, provider number registered, primary gateway is MCOL).
  3. Submits the bulk-bill claim to Services Australia in the background.

The practitioner doesn't open the claim panel. The claim simply appears in the Claims hub at status Sent (or in the manual claim path if a precondition fails).

This page explains who should turn it on, what happens when you complete an appointment, and the safety nets that stop a bad submission from going to SA.

When to turn it on​

Auto-submit is a productivity win for practices that:

  • Run bulk-bill clinics where every appointment uses the same MBS item series for the services they provide.
  • Have a steady DB4 consent capture step at intake — you record DB4 before every bulk-billed claim.
  • Have already lodged HW027 for every (practitioner × location) pair and seen at least one manual claim assess cleanly.

Auto-submit is not a fit for:

  • Mixed bulk-bill / patient-claim practices where the practitioner decides bill mode per appointment. The setting is org-wide, not per-appointment.
  • Practices that want a practitioner to review the MBS item before every submission (e.g. complex specialist work).
  • The first 1-2 weeks after PRODA / HW027 registration. Manually submit a handful of claims first and confirm they assess as expected.

Turning it on (or off)​

Settings → Medicare → PRODA & claiming.

Toggle Auto-submit Claims. The change is org-wide and takes effect immediately — the next appointment your team marks complete will trigger the flow. Toggle it off and automatic claiming is a no-op again.

Behind the scenes this updates the auto-submit preference for your organisation. The change takes effect immediately on the next appointment completion event.

The precondition checklist​

When an appointment is marked complete, Praxi runs a series of checks in order. If any fails, no claim is submitted, and the practitioner can still submit manually from the invoice page.

CheckWhy it matters
Auto-submit Claims is onOpt-in only. Default is off.
Primary gateway is MCOLThis appointment-completion option applies to Medicare Online claims.
Auto-invoice has materialisedAn invoice must exist before the claim can be submitted.
No claim already in flightIf an active claim already exists for the appointment, automatic claiming skips — the same completion event firing twice can never double-submit.
DB4 consent on fileBulk-bill submission without DB4 violates SA's section 20A rules. If no valid consent record is found, the claim is skipped.
Patient verifiedA verification from the last 24 hours is reused; if it is stale, automatic claiming verifies the patient with Services Australia before submitting.
Invoice has claimable itemsAn invoice with no Medicare-claimable line items produces no claim.

If a precondition fails, the appointment-completion path still succeeds — the practitioner sees the appointment marked complete, and the manual Submit Medicare Claim button is still available on the invoice. Failures are logged to Praxi for support follow-up but never raised as user- facing errors.

What the practitioner sees​

When auto-submit fires successfully:

  • The appointment moves to Complete.
  • The invoice is created with the MBS line item.
  • Open Finance > Claims and choose Medicare to check the submitted claim.
  • Follow the claim through Sent, Approved and Paid, or resolve a rejection under Needs action. Assessment and payment happen separately.

See Medicare claims in Finance and Record bulk-bill consent.

The verification pre-warm​

Each morning, Praxi runs a scheduled job that pre-verifies every Medicare patient with an appointment booked in the next 24 to 48 hours -- tomorrow's clinic list.

The effect: most patients are already verified before their appointment starts, so automatic claiming can reuse a fresh verification when the appointment completes. If the verification is stale (or the patient was added the same day -- walk-ins, urgent bookings), automatic claiming verifies the patient with Services Australia on the spot before submitting.

Auto-submit still requires the client's assignment of benefit before each bulk-billed claim. Review Record bulk-bill consent for the available methods, including authorised representatives when the client cannot sign. Verbal assignment is accepted for services through 30 June 2027.

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Verified against the current Praxi product surface on 2026-06-05.