In-Patient Medical Claim Web Service (IMCW) function is the claiming process that allows health professionals and hospitals to transmit an In-Patient Medical Claim to Services Australia using web services (WS).
An IMCW relates to claims for admitted patients’ episodes of care where financial claim(s) are lodged by providers or agents against Medicare, and in most cases a private health insurer (PHI), on behalf of a patient for the provision of health care services.
There are five types of IMCW available:
IMCW Agreement (IMC AG)
The provider has signed an Agreement with the PHI (of which the patient is a member) specified in the claim.
Payment is sent from Medicare to PHI where the PHI makes a consolidated payment to the Provider.
IMCW Scheme (IMC SC)
The provider is operating under a scheme with the PHI (of which the patient is a member).
Payment is sent from Medicare to PHI where the PHI makes a consolidated payment to the Provider.
IMCW Patient Claim (IMC PC)
Patient is a member of the PHI specified in the claim.
If the claim has been paid, the payment from Medicare goes to the patient or claimant and payment from the PHI goes to the member.
If the claim has not been paid in full, the payment from Medicare and the PHI goes to the patient or claimant, via cheque (made out to the provider), who then passes it on to the provider.
IMCW Billing Agent, Medicare and Private Health Insurer (IMC MB)
Payment from both Medicare and the specified PHI goes to the specified Billing Agent.
IMCW Medicare only (IMC MO)
Payment from Medicare goes to the specified Billing Agent.
There is no PHI involvement.