Monthly Claim Batch and Claims Sync

For residential aged care, you do not build a subsidy claim line by line. Services Australia calculates the monthly subsidy from the events and classifications you submit during the month. Your job each month is to bring that calculated position back into Maica, check it, and act on what it tells you. The Claim Batch record is where that happens, and the Claims Sync action is how you pull the current position from Services Australia.

This article explains what a Claim Batch is, how the monthly cycle fits together, and how to use the Claims Sync action to retrieve and review your claim.

This article covers the resident-facing monthly claim. For how daily invoices are generated in the first place, see How Resident Billing Works. For matching Services Australia payments back to your invoices once the claim is paid, see Reconciling Payments.

What a Claim Batch is

A Claim Batch represents one service's residential care claim for one claim month. It groups the month's claim data for a single Location (your service) and holds the confirmed position once Services Australia has calculated it.

Each Claim Batch carries three pieces of identifying information that must be in place before you can sync:

On the Claim Batch	What it is	Why it matters
Location	The service the claim is for	The claim is scoped to one service; the Location carries the Service ID and Service NAPS ID used in the sync
Claim Period Start Date	The first day of the claim month	Maica derives the claim month from this date, so it must be set before syncing
Services Australia Provider ID	The provider the claim is submitted under	Identifies which provider the claim belongs to, important where an organisation operates under more than one provider ID

The Claim Period Start Date drives everything. Maica normalises it to the first day of its month and derives the claim month from it. If it is not set, the Claims Sync action stops and asks you to set it before continuing.

The Claim status

The Claim Status on the Claim Batch tells you where the claim sits. It moves forward through the month as Services Australia processes it, and the sync updates it to match. It never moves backward.

Claim Status	What it means
New	The Claim Batch has been created in Maica but not yet matched to a claim at Services Australia
Submitted	Services Australia has the claim open for the month
Being Calculated	Services Australia is calculating the monthly subsidy
Pending Approval	The claim is with Services Australia awaiting approval
Approved	Services Australia has confirmed the claim for payment, and the confirmed data has been written into Maica
Completed	The claim month is closed
Cancelled	The claim has been cancelled

You do not set the Claim Status by hand as part of normal claiming. It reflects the position Services Australia reports back, and the Claims Sync action keeps it current.

Where the monthly Claim sits in the cycle

The claim is one stage in a repeating monthly rhythm. Understanding the order helps you know when to run the sync and what to expect from it.

1. Billing runs through the month. The daily billing engine generates each resident's invoices as it does every day. See How Resident Billing Works.

2. Accommodation balances are submitted. Toward month-end you report each resident's RAD/RAC balance to Services Australia. See Reporting RAD/RAC Balances.

3. You sync the claim. You open the Claim Batch and run Claims Sync to pull the current calculated position from Services Australia into Maica.

4. The claim is approved and paid. Once Services Australia approves the claim, the confirmed subsidy data lands in Maica, and payment follows.

5. You reconcile the payment. When the payment arrives, you match it against the invoices you raised. See Reconciling Payments.

Because Services Australia calculates the claim rather than receiving one you build, most of the claim work is reviewing what the sync brings back, not data entry.

Running Claims Sync

Claims Sync is the action that pulls the current claim position from Services Australia and writes it onto the Claim Batch and its related records. You run it from the Claim Batch record.

Before you start

Prerequisites: The Claim Batch must have a Location, a Services Australia Provider ID, and a Claim Period Start Date. A working PRODA connection for Aged Care must also be in place. If the Provider ID is not set, the sync prompts you to confirm it before it will run.

What the sync does

When you run Claims Sync, Maica works through a set of steps in order, each retrieving one part of the monthly picture from Services Australia and writing it into Maica. The steps run one after another, and if one fails the sync stops there so you can resolve the problem and run it again.

Step	What it brings back
Payment summary	The payments Services Australia has recorded for the service this month, including advance and claim payment amounts and dates
Claim details	The claim status, the Services Australia operational bed count, and the claim submission position for the month
Respite summary	Respite allocation and usage figures, and residential respite incentive (RRI) figures where they apply
Care recipient details	The per-resident detail behind the claim, refreshed for the residents in the claim month
RN supplement summary	The 24/7 registered nurse supplement figures for the service, stored against the Location
Reconciliation	Matches the confirmed position against your invoices and prepares any adjustments

Some steps may show warnings rather than a clean result. A warning does not mean the sync failed; it flags something in that step's data that is worth reviewing, such as a resident the claim could not match. The step still completes and the sync moves on.

After the sync

Once the sync completes, the Claim Batch shows the current position:

• The Claim Status reflects where Services Australia has the claim.

• The payment summary shows the advance and claim amounts and their dates.

• The claim details show the operational bed count and submission date.

• The Claim Last Sync time records when the claim data was last refreshed, so you can see how current it is.

You can run Claims Sync as often as you need through the month. Each run refreshes the Claim Batch with the latest position from Services Australia, so it is safe to re-run whenever you want to check where the claim stands.

What happens when the Claim is approved

When Services Australia approves the claim, the sync writes the confirmed data across several records so the approved subsidy position is reflected throughout Maica:

Record	What the approved claim populates
Claim Batch	The confirmed claim status, operational bed count, registered nurse eligibility, and the last sync time
Funding Item	One record per resident for the claim month, including the supported resident status
Claim Service Classification	The service-level classifications confirmed for the month
AN-ACC Classification	The resident-level AN-ACC classifications confirmed for payment

The registered nurse eligibility written to the Claim Batch here comes from the claim itself. It is not the same as the separate 24/7 registered nurse coverage check you run for your own GPMS reporting. The two are independent.