{"templateId":"markdown","sharedDataIds":{"sidebar":"sidebar-docs/sidebars.yaml"},"props":{"metadata":{"markdoc":{"tagList":[]},"type":"markdown"},"seo":{"title":"BIR workflow","llmstxt":{"hide":false,"sections":[{"title":"Table of contents","includeFiles":["**/*"],"excludeFiles":[]}],"excludeFiles":[]}},"dynamicMarkdocComponents":[],"compilationErrors":[],"ast":{"$$mdtype":"Tag","name":"article","attributes":{},"children":[{"$$mdtype":"Tag","name":"Heading","attributes":{"level":1,"id":"bir-workflow","__idx":0},"children":["BIR workflow"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Bulk Bill reconciliation takes place between the vendor's PMS and Medicare. Tyro only controls the submission of claims via Easyclaim, at the time of service."]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["We hope the following assists with a vendor's scoping of how to build BIR."]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":2,"id":"what-can-be-retrieved-from-medicare","__idx":1},"children":["What can be retrieved from Medicare"]},{"$$mdtype":"Tag","name":"ul","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Process status of a claim."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Amount for a claim."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Payment date/Payment run for a claim if it has been processed."]}]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":2,"id":"what-can-not-be-retrieved-from-medicare","__idx":2},"children":["What can not be retrieved from Medicare"]},{"$$mdtype":"Tag","name":"ul","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":["When will a claim be paid if it has not been paid in a payment run."]}]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":2,"id":"tyros-observation","__idx":3},"children":["Tyro's observation"]},{"$$mdtype":"Tag","name":"ol","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Medicare will process an arbitrary amount of claim transactions, group them in a payment run, and payout."]},{"$$mdtype":"Tag","name":"ul","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":["We do not know how Medicare group these claim transactions."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["We can only find out when Medicare will pay once it has been paid via a payment run."]}]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Some claims may take multiple days to be processed by Medicare"]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["We are unclear of the exact classification of the settlement date for a given claim."]}]}]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":[{"$$mdtype":"Tag","name":"strong","attributes":{},"children":["Given the scenario below"]}]},{"$$mdtype":"Tag","name":"ul","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Provider did 10 claims for Day1 $10 each total of $100."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Claim 1~10 gets put into ClaimBatchA001."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["On Day2, Medicare reports Claim 1~8 processed with total $80 paid in PaymentRunA."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["On Day3, Medicare reports Claim 9 processed with total $10 paid in PaymentRunB."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["On Day4, Medicare reports Claim 10 rejected"]}]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["We believe what may happen with vendors is on Day2, they try to match $80 payment from Medicare with $100 expected for their nominated 'batch'."]},{"$$mdtype":"Tag","name":"ul","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":["On Day3, they try to match $80 + $10 with $100 expected."]}]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Since Medicare does not do a payment run with the same transactions they have in a batch, the reconciliation does not match."]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":2,"id":"recommended-approach","__idx":4},"children":["Recommended approach"]},{"$$mdtype":"Tag","name":"ul","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Do not assume you can group a number of claim transaction and assume Medicare will pay for all transactions in the group in a single payment run."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Reconcile each claim transaction individually"]}]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":[{"$$mdtype":"Tag","name":"strong","attributes":{},"children":["It probably should be like the following:"]}]},{"$$mdtype":"Tag","name":"ul","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":["On Day2, retrieve payment report for ClaimBatchA001 (this means check payment/process for each individual Claim 1~10, Medicare does not have concept of this ClaimBatchA001)."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Claim 1~8 as reconciled and paid."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Report should show ClaimBatchA001 as $80/$100 paid. with $20 pending. Status: PENDING PAYMENT."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["On Day3, retrieve payment report for ClaimBatchA001. (this means check payment/process for Claim 9 and 10 only)."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Should mark Claim 9 as reconciled and paid."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Report should show ClaimBatchA001 as $90/$100 paid, with $10 pending. Status: PENDING PAYMENT."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["On Day4, retrieve payment report for ClaimBatchA001. (this means check payment/process for Claim 10 only)."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Medicare has rejected Claim 10."]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":["Report should indicate ClaimBatchA001 as $90/$90 paid. $10 rejected. Status: EXCEPTION!"]}]}]},"headings":[{"value":"BIR workflow","id":"bir-workflow","depth":1},{"value":"What can be retrieved from Medicare","id":"what-can-be-retrieved-from-medicare","depth":2},{"value":"What can not be retrieved from Medicare","id":"what-can-not-be-retrieved-from-medicare","depth":2},{"value":"Tyro's observation","id":"tyros-observation","depth":2},{"value":"Recommended approach","id":"recommended-approach","depth":2}],"frontmatter":{"title":"BIR workflow","seo":{"title":"BIR workflow"}},"lastModified":"2026-10-02T05:06:47.000Z","pagePropGetterError":{"message":"","name":""}},"slug":"/docs/in-person-payments/pay-in-person/features/medicare-easyclaim/bir-workflow","userData":{"isAuthenticated":false,"teams":["anonymous"]},"isPublic":true}