Medicare & Billing
EPC and chronic condition claiming software
Allied health services under a GP chronic condition management plan (still widely called EPC) are capped at five Medicare-funded services per patient per calendar year, across all providers. Each claim depends on a GP referral that usually arrives as a scanned form. Claiming software has to track both.
Common challenges
What teams struggle with
Caps shared across providers
Medicare counts the five services across every allied health provider the patient sees, so your own count can be wrong.
Referral details on paper
The referring GP's provider number, name and the referral date usually come from a scanned or photographed form.
Counts that drift
Visit counters edited by hand, reversed, or carried over from old systems end up not matching what Medicare has recorded.
Plan transitions
The 2025 move from GP management plans and team care arrangements to GP chronic condition management plans changed the paperwork staff see.
How we help
Practical solutions that ship
Entitlement ledger
One ledger entry per patient per service date, so visits aren't counted twice or reversed into the wrong period.
AI-assisted referral reading
Referral forms are read automatically, with a confidence score and supporting evidence for each field, then checked against provider number check digits.
Cap-aware export
Claims that would take a patient over their annual cap are held back before submission, not left for Medicare to decline.
Cap rejection handling
When Medicare reports the cap has been used at another provider, the patient's entitlement is updated and the service moves to private billing.
Frequently asked
Questions about epc and chronic condition claiming software
How many Medicare allied health services can a patient claim?
Under chronic condition management arrangements, eligible patients can claim up to five allied health services per calendar year in total across disciplines and providers. Check MBS Online for current rules.
Can AI read referral forms reliably?
It can read most of them, as long as every value comes with a confidence score and evidence, is checked against check digits, and goes to a person to review when confidence is low. We don't submit an unverified AI-read value to Medicare.
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