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DVA Claims

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.

Praxi supports direct billing to the Department of Veterans' Affairs (DVA) for eligible veterans and their dependants. This guide covers card types, billing setup, claim submission, and common rejection handling.

Psychology claims use service type K

DVA Allied Health Psychology (VAAW) claims are submitted with serviceTypeCode = 'K'. That is not Medicare's specialist code 'S'. Praxi sets K automatically for psychology claims — you do not pick it in the UI. Every psychology claim also needs a referral (TECH.SIS.DVA.02 §4.8); Praxi blocks submission until referral details are present.

DVA Card Types​

CardColourCoverage
GoldGoldAll clinically necessary health services -- no accepted disability required
WhiteWhiteFor psychology services, only conditions on the cardholder's accepted disability list are covered. DVA White Cards cover all accepted disabilities -- for psychology specifically, the disability must be a mental-health condition on the card or have been added via DVA's Non-Liability Health Care (NLHC) provisions. Accepted disability must be specified on the claim.
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White card holders can only receive DVA-funded treatment for their accepted conditions. If the presenting issue is unrelated to the accepted condition, you must bill via another funding source (e.g., Medicare or private). Orange cards cover pharmaceutical benefits only and are not applicable to psychology services.

Treatment Cycles​

DVA psychology services are structured in treatment cycles of up to 12 sessions or 12 months, whichever comes first:

  • Praxi automatically tracks treatment cycle dates from claim responses
  • Daily reminders begin 14 days before a cycle expires
  • When a cycle reaches its limit, Praxi blocks further claims until an End of Cycle Report (US92) is submitted -- a new cycle then begins
  • Group sessions count as consultations within the treatment cycle — per DVA's provider guidance there is no separate group-session allowance, so a group session uses one of the cycle's 12 sessions like any other consultation
Horizon — from 1 July 2027

Budget 2026–27 announces that the 12-session / 12-month treatment cycle will be removed, allied health fees increase, and a $5,000 annual monetary limit / clinical-effectiveness threshold per financial year applies to allied health for Veteran Card holders — with a pathway for DVA to fund care above $5,000 where clinical need is demonstrated. Open Arms psychology/counselling does not count toward the $5,000. Operational detail is still under consultation (from August 2026). Praxi continues to enforce current cycle rules until DVA publishes binding arrangements and product is updated. See dva-allied-health-cap-2027 SSOT and DVA provider news.

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Couples counselling: DVA does not fund relationship or couples therapy. Only family therapy related to a veteran's accepted conditions may be funded. Praxi blocks couples counselling claims for DVA-funded clients automatically.

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No gap charges: DVA operates on an "accepted fee" basis. The DVA schedule fee is the total fee — you cannot charge gap fees or co-payments to DVA clients.

Setting Up DVA Billing​

  1. Navigate to Settings > Medicare (DVA claiming uses the same MCOL connection)
  2. Each practitioner needs a valid Medicare provider number registered with the claiming location
  3. Confirm your practice location details

For each client:

  1. Open the client record's Billing tab and find the Funding Sources section
  2. Click Add Funding Source > DVA
  3. Enter the DVA file number and card type
  4. For White card holders, record the accepted conditions

Submitting Claims​

  1. Ensure the veteran has a DVA file number and card type on the client record (entered at intake or under Funding). File numbers are encrypted at rest; you do not re-type them on every claim.
  2. Complete the appointment and mark it as attended (or raise the invoice from the session).
  3. Create the invoice with a DVA item number (not an MBS Better Access code) and the correct DVA schedule fee.
  4. Confirm a referral is on the claim (from the appointment-linked referral or entered on the claim panel). Psychology claims without a referral are refused before transmission.
  5. For White Card claims, select the accepted disability from the dropdown.
  6. Click Submit to DVA. Claims go electronically via MCOL.

After-hours, public holiday and travel​

  • After-hours and public-holiday services are claimed by selecting the matching item number from the DVA fee schedule — DVA publishes distinct item codes for these service types, so there is no separate toggle in Praxi. Pick the correct item and the schedule fee follows.
  • Kilometres -- For visit-type claims where you travel to the veteran, enter the distance travelled (only available when treatment location is set to Visit)

Treatment Location Codes​

CodeLocationDescription
RRoomsVeteran attends your practice (default)
VVisitYou travel to the veteran (kilometres apply)
HHospitalService provided in a hospital setting

DVA Fee Schedule​

DVA maintains its own fee schedule, which differs from MBS rates. Praxi applies DVA item numbers and scheduled fees from the practice catalogue (DvaItem) when a DVA funding source is selected — not Medicare MBS rates.

Official schedules (PDFs by profession, typically updated 1 July / 1 November / 1 January): Dental and allied health fee schedules. Praxi’s mental-health allied seed tracks version 2026-07 (effective 1 July 2026). Schedule updates are applied by ops seed / admin when DVA publishes new PDFs — policy-watch watches the hub for change signals; it does not auto-import fees into production.

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DVA pays the schedule fee to the provider; do not charge the veteran a gap on schedule items. Ensure you use DVA US-series item numbers, not MBS items, when billing DVA clients.

Prior Approvals​

Continuing past a treatment cycle uses the End of Cycle Report (US92) -- when a cycle reaches 12 sessions or 12 months, Praxi blocks further DVA claims and prompts you to complete the US92; a new cycle then begins. Separately, trauma therapy requires DVA prior approval to continue beyond 8 sessions -- that request goes directly to DVA through your contract arrangements.

End of Cycle Reports​

When a treatment cycle is approaching completion, Praxi automatically generates End of Cycle report data. A daily check runs at 7:00 AM AEST to identify expiring cycles, and reminders are sent daily over the final 14 days of the cycle.

Common Rejection Reasons​

ReasonResolution
Card expired or invalidAsk the client to contact DVA to confirm eligibility
Condition not accepted (White card)Verify the condition is listed on the client's White card
No prior approvalSome services require DVA pre-approval; submit a request before the appointment
Incorrect item numberCheck the DVA fee schedule for the correct item
Duplicate claimReview claim history and void the duplicate

DVA Verification​

Before submitting a DVA claim, Praxi verifies the veteran's eligibility with Services Australia automatically when a client's DVA details are added or updated. The verification result is cached and displayed on the client record.

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DVA file numbers are encrypted at rest for Privacy Act compliance. The decrypted file number is only visible to authorised staff during the claiming workflow.

Reconciliation​

DVA payments are reconciled in the same workflow as other funding sources:

  1. Go to Billing > Reconciliation
  2. Filter by DVA funding source
  3. Match incoming payments to submitted claims
  4. Flag and investigate any discrepancies

Who can manage DVA claims​

DVA claiming follows the same role model as bulk bill and patient claims. Practitioners and interns (under supervision) submit for their own clients. Practice owners and practice managers submit organisation-wide. Receptionists can submit within own-scope. Accountants cannot submit DVA or Medicare claims — they retain reconciliation reporting only. See the Medicare permissions matrix.

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SA spec conformance — Verified against TECH.SIS.DVA.02 V1.0.08 (DVA Allied Health VAAW) on 2026-05-14.