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Medicare & ECLIPSE: Claiming Errors & How to Fix Them

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This article explains how to understand and resolve Medicare and health fund claiming errors in MediRecords. It covers the difference between claim-level and service-level rejections, what return codes (4-digit) and reason codes (3-digit) mean, and practical fixes for common codes. This applies to any practice submitting Medicare, DVA, or ECLIPSE claims. 

📌 Important: Your billing configuration determines whether invoices, payments, adjustments, and refunds can be created or edited in any practice, or only in the one you're logged into. With Centralised Billing enabled, you can bill across practices, but be sure to select the correct one. Disabling Centralised Billing locks billing to the current practice to reduce errors. For more information, see Centralised Billing.

 

Contents:

  1. General Troubleshooting
  2. Understanding Medicare Error Codes
  3. Rejection Scenarios - Claim vs Service Rejections
  4. Reason Codes - 3 Digit Codes
  5. Return Codes - 4 Digit Codes
  6. Error Specific Solutions

 

General Troubleshooting

If you submit a Medicare claim and the claim is unsuccessful, MediRecords will display a message stating the error code.

General Troubleshooting:

  • All claims submitted to Medicare, DVA or Private Health Funds are visible from claims circle 2 of 3, titled In Progress.
  • PCI claims move directly to claims circle 3 of 3, titled Claims Completed this Week, as soon as the invoice has been finalised.
  • PCS claims are visible from claims circle 1 of 3, titled Unclaimed Amount, until submitted.
    • Once submitted, PCS claims move directly to claims circle 3 of 3, titled Claims Completed this Week.
  • Invoices sitting in the Unclaimed Amount stage and highlighted in red cannot be claimed until either:
    • The patient has successfully passed an OPV (Online Patient Verification), OVV (Online Veteran Verification) or PVF (Patient Verification Fund) check, whichever is relevant to the claim type, or
    • Your MediRecords account has been successfully configured for Medicare claiming.

The meaning of each error, and the steps to take to resolve it, are documented within the Claiming Rejections & Errors section of the Knowledge Base. This article provides general information on the steps to take to understand and resolve a claim failure.

 

Understanding Medicare Error Codes

There are two types of codes involved in claiming: return codes and reason codes.

Return codes are 4 digit codes that are returned when there is an issue with the submission of the claim to Medicare. These codes are automatically generated by the gateway of the claiming channel and generally indicate an issue with how the information was sent.

A return code also includes a message about why the claim was rejected, or how it was assessed by the gateway. This information allows you to identify claiming errors, make corrections, and potentially re-submit the claim. There are 764 codes to date.

Reason codes are 3 digit codes that are given when the claim has passed the gateway and has been assessed by the claiming team, either automatically or through manual intervention by an operator. This generally indicates an issue with the information that was sent.

Reason codes are used in processing reports and in the Medicare statement of benefits, and are similar to return codes in that they also provide a message about how a claim was assessed. This can range from scenarios such as the use of an incorrect Medicare Benefits Schedule (MBS) item, issues with the eligibility of patients or health professionals, to the need for extra details to assess the claim.

 

Rejection Scenarios - Claim vs Service Rejections

Scenario 1: The Entire Claim Was Rejected

Cause: Medicare has rejected the entire claim. This is immediately visible by checking the status of the claim in the In Progress section, where the status will show in red as Rejected.


 

To check the reason the claim was rejected, hover your mouse over the small (i) icon. Medicare's reason for rejection will be provided, along with a suggestion of what to rectify.


 

Resolution:

  1. Action any recommendations provided in the rejection reason.
  2. Tick the claim.
  3. Click More.
  4. Select Re-Submit Claim.


 

Escalate when: If the claim continues to be rejected after you have actioned Medicare's stated reason and resubmitted, contact MediRecords Support.

 

Scenario 2: The Service(s) Was Rejected

Cause: If a claim in the In Progress section remains in a status of Processed with an amount owing, this indicates that one or more of the services within the claim require action.

Resolution:

  1. Tick the box next to the claim.
  2. Click View Services.
  3. Hover your mouse over the description to see the full reason for what was missing or incorrect with that item or invoice.
CLAIM.gif


 

When a service has not been paid, you have one of two options:

  • Re-submit the item to try again for payment, making any necessary changes.
  • Accept the item, to confirm you're happy with non-payment, close the claim, and write off the invoice.

Option A: Re-submit

  1. Tick the item(s).
  2. Click Re-Submit.

Note: Selecting Re-Submit causes MediRecords to automatically retrieve any Process and Payment Reports associated with this claim.

  1. Click Yes on the confirmation prompt.

The original invoice will be fully adjusted, and a new cloned invoice will be generated. This new invoice is almost identical to the original, the only updated field will be the invoice number. You can now make adjustments to the invoice.

  1. Once you have finished updating the invoice, click Claim.

This invoice will now appear on the Unclaimed Amount screen, ready to be resubmitted.

Option B: Accept

  1. Tick the item.
  2. Click Accept Claim.

This moves the claim to Claims Completed, and the original invoice is adjusted (written off) in the patient's accounts section.

 

Escalate when: If a service continues to be rejected after resubmission with corrected information, contact MediRecords Support for further investigation.

 

Reason Codes - 3 Digit Codes

Reason codes are 3 digit codes assessed by the Medicare claiming team. The table below lists the most common reason codes and how to resolve them.

Code Description Steps to Resolve
101 More details of service required to assess benefit Check the failed item number on the claim has the required additional information to be assessed, e.g. after hours, not a duplicate service.
120 Age restriction applies to this item Confirm the patient's recorded age has been stored correctly in MediRecords. If the patient's age is correct, the patient is not eligible for this service item.
125 Not payable without associated operation/anaesthetic item Update the claim to include the associated operation/anaesthetic item code. Update the claim and re-submit.
136 Referral details not supplied, paid at GP rate Check the billing Provider's Medicare Provider Type in User Preferences, and confirm that Include Referral for Medicare Billing is checked, to ensure future claims are assessed at the correct rate.
141 No benefit payable for services performed by this provider The provider may not be eligible to bill this item, or may need to renew their registration with Medicare.
157 Service possibly aftercare - refer to provider Check the type of service provided, and indicate aftercare if you re-submit the invoice.
159 Item associated with other service on which benefit payable If the service is eligible for a Medicare benefit (for example, it was not performed on the same occasion, is not associated with the other service, or was not performed through the same incision), then for Online Claims: check the failed item to ensure required information has been included, e.g. start time and end time of service. You may also wish to include additional information with the item in free text so it can be assessed correctly. For certain MBS items, you can use the MBS Items Online Checker in HPOS to check eligibility before you lodge the claim. Log on to HPOS to see which items can be checked using the MBS Items Online Checker.
162 Benefit has been previously paid for this service Medicare is viewing this service as a duplicate. Please follow the guidance in the Claiming Rejections & Errors section on the steps to re-submit.
253 Radiotherapy assessed with other item number on statement The amount will need to be written off, as it has been paid under the base item.
267 Service not payable - associated service not present Review the MBS rules for the item(s) and ensure associated service items are included in the re-submission.
307 Claim not paid - card number not valid for date of service The patient needs to check their card details with Medicare. Update the patient record with the correct details before re-submission.
377 Number of patients seen not indicated Re-submit the claim(s). If still rejected, contact MediRecords Support.
412 Benefit not payable - provider unable to claim this service Check the provider's registration with Medicare and their eligibility to bill the item(s).
434 Expired or invalid card. Benefit not payable The patient needs to be issued a new card by Medicare.
502 Patient is not eligible to claim benefit for this item The patient must check their eligibility with Medicare regarding the item(s) billed.
507 Site not accredited for this service Contact Medicare to check your minor site ID and other practice registration details.
516 Benefit paid for base and derived radiotherapy items claimed The amount will need to be written off, as it has been paid under the base item.
525 Only attracts benefit when claimed via bulk billing Re-submit the claim as a bulk billing service.
529 Bulk bill additional item claimed incorrectly The items claimed together do not follow eligibility rules. Review the rules listed for the item on the MBS website.
536 Location specific practice number not supplied Duration of Service and LSPN (Location Specific Practice Number) cannot be submitted together for the same item. Remove Duration of Service only from Group T2 Radiation Oncology items, Subgroup 3 Megavoltage items, Subgroup 4 Brachytherapy items, and Subgroup 5 Computerised Planning items (except diagnostic x-ray planning items 11509, 11512 and 11515, and non-CT interfacing planning items 11527, 11530 and 11533). Duration of Service should never be sent with Diagnostic Imaging Service items.
567 Benefit paid on main diagnostic imaging item The amount will need to be written off, as it has been paid under the base item.
600 Requesting/referring provider unable to be identified Contact the referring/requesting provider for valid details.
607 Referral date has been omitted Check and amend the referral details.
616 Item cannot be claimed as in hospital service Review the item(s) rules on the MBS website.
617 Item cannot be claimed as out of hospital service Review the item(s) rules on the MBS website.
642 Benefit paid for derived and other item claimed The amount will need to be written off, as it has been paid under the base item.
710 Associated surgical items not present Review the item rules on the MBS website, raise a new invoice and include the appropriate items.
714 Benefit not determined - number of time units not present Check the information being submitted, amend it, and re-submit. If this persists, contact MediRecords Support.
732 Referral period not valid for referring provider Check the dates with the referring provider, as a new referral may need to be issued.

 

Return Codes - 4 Digit Codes

Return codes are 4 digit codes generated by the gateway of the claiming channel. The table below lists the most common return codes and how to resolve them.

Code Description Steps to Resolve
1006 PKI login failure. There may be a problem with the PKI certificates installed. They may have expired, or another issue has been identified. Upload your PKI certificates again. If the error persists, contact Medicare directly.
1007 Transmission failure. Attempt to re-submit the claim.
1008 Medicare Online Claiming already operational Sign out and sign back into MediRecords, then attempt to submit again.
1703 Client Adaptor session does not exist Re-submit the claim.
1704 Desecure failure Your connection to Medicare has been temporarily disrupted. Check your internet connectivity and submit again.
1705 Secure failure This is related to the certificates. Check with Medicare what has been uploaded.
1712 HTTP server error Refresh the page. Sign out and sign back into MediRecords. Check your internet connection (recommended download speed is 18 Mbps). If the problem persists, contact MediRecords Support on 1300 103 903 or email support@medirecords.com.
2016 No service exists in the claim for the supplied service ID Re-submit and ensure the items are included.
2030 The data element being set is inconsistent with other data elements already set, or a data element has been set and a related conditionally required data element has not been set Two or more pieces of information within the claim cannot be submitted together. Review and re-submit.
2032 The maximum number of services allowable for the voucher has been reached The maximum number of items that can be claimed in one invoice is 14. Submit another claim if you exceed this amount.
2038 The referral/request type is inconsistent with the service type set for this claim Check the details of the claim, amend, and re-submit.
3003 The Medicare server is not operational. Try again later. If the problem persists, contact the Medicare eBusiness Service Centre. Contact Medicare regarding the claim submission.
3004 The request cannot be dealt with at this time because real-time processing is not available or the system is down. Contact the Medicare eBusiness Service Centre for further assistance. Check the Medicare status pages, as the server may be down.
3013 The signing Location is unknown. For further assistance contact the Medicare eBusiness Service Centre. Check that your Minor Site ID/Location Code has been registered appropriately.
3021 The sending Location could not be identified at the Server. Contact the Medicare eBusiness Service Centre for further assistance. Check that the RA number and HSS (Minor ID) number are registered correctly with Medicare for this site. Also check that the practitioner's Provider Numbers are registered correctly against the Minor ID number.
3029 HTTP redirection attempted Check your internet connection and try again.
3031 The server cannot fulfil this request Check your internet connection. Also check the Medicare status page.
5010 The subscription ID supplied has been identified as in-active Check if the provider number of the servicing practitioner is valid.
8005 The individual has been matched using the submitted data, however differences were identified. Check the information returned and update your records. After the OPV check, hover your cursor over the OPV button in the patient file to see what details are listed with Medicare, and edit the patient record accordingly.
9003 The provider is identified as inactive for Online Claiming purposes. Contact the PKI Customer Service Centre for assistance. The provider must check their provider number registered with Medicare.
9006 The Provider is not authorised to participate in Online Claiming. Contact the Medicare eBusiness Service Centre for further assistance. Check the servicing provider's details, as they may not be eligible to provide this service item at the date of service. For more information, contact eBusiness.
9007 The Location is not authorised to undertake the function on the date of transmission. The transmission has been rejected. Contact the Medicare eBusiness Service Centre for further assistance. Check the practice and provider's eligibility to bill for the service. Contact Medicare if needed.
9119 The provider is identified as inactive for Online Claiming purposes. Contact the PKI Customer Service Centre for assistance. Check the provider's registration with Medicare.
9120 The Individual Certificate used has been revoked by the Registration Authority. Contact the PKI Customer Service Centre for assistance. Contact eBusiness.
9123 The HCL Certificate used to sign the transmission is not the Certificate currently registered against the Location Id This error code is caused by multiple locations using the same email address on their certificates. To resolve, contact Medicare.
9201 Invalid format for data item Some required information is missing or has been entered incorrectly. Check all details being submitted, including that the gender has been entered correctly.
9202 Invalid value for data item. The data element does not comply with the values permitted or has failed a check digit check. There are discrepancies with the data being sent to Medicare for that claim, which may relate to patient details (e.g. address), the provider (e.g. provider number) and/or the item number(s) submitted. Check all details and ensure no miscellaneous characters are used. Also check that you are using the correct billing schedule, as this may cause this issue.
9204 Date in future. The date supplied must not be in the future Review the service dates on the claim and re-submit.
9301 Patient's Medicare card number must be supplied Check the detail on the patient file, run an OPV check, and re-submit.
9302 Patient's reference number must be supplied Check the detail on the patient file and re-submit.
9303 Patient's first name must be supplied Check the detail on the patient file and re-submit.
9304 Patient's family name must be supplied Check the detail on the patient file and re-submit.
9305 Servicing Practitioner's Provider Number must be supplied Check the claim and the provider number listed, and re-submit.
9306 Date of service must be supplied Check the claim and re-submit.
9307 An item number must be supplied for each service Check the item numbers on the claim and re-submit.
9308 Referring Practitioner's Provider Number must be supplied Amend the referring provider information and re-submit.
9309 Referral issue date must be supplied, and must be prior to, or the same as, the date of the medical service, cannot be before the date of birth, nor after the referral start date Check the referral/request date entered.
9310 Requesting Practitioner's Provider Number must be supplied Amend the requesting provider information and re-submit.
9311 Request issue date must be supplied, and must be prior to, or the same as, the date of the medical service, and cannot be before the date of birth Check the referral/request date entered.
9312 Claimant first name, family name, date of birth, claimant Medicare card number and reference number must be supplied. If any one data element is supplied, then all five must be supplied. Check all details listed on the patient file are correct before re-submitting the claim.
9316 The Referring/Requesting Provider cannot be the Servicing or Principal Provider Ensure the same provider is not listed for both, amend the claim, and re-submit.
9322 Referral period details must be supplied Check the referral/request date and other details entered.
9338 A required charge amount has not been supplied or is inconsistent with other data supplied. Check the item amount, amend as required, and re-submit the claim.
9341 More information required. Either text must be keyed against a service or a time supplied for the voucher. If using procedural items, include times and duration.
9364 Patient information provided is insufficient Check the detail on the patient file, run an OPV check, and re-submit.
9427 Service start date must be on or after the patient's date of birth and on or before the date of service and service end date. The item is not covered for this patient at this date of service. Raise a new invoice and submit.
9601 Claim successfully transmitted and pended for further assessment by a Customer Support Officer. The claimant will be advised of the outcome by mail. No further action is required. The claimant will be advised of the outcome directly by Medicare.
9602 This claim cannot be lodged through this channel. Submit the claim via an alternative Medicare claiming channel. This error most often occurs when the Provider Type is incorrect for the item being claimed, for example an item that requires an Allied Health provider type being claimed under a General provider type. Check Provider Preferences > Invoices > Medicare Provider Type and confirm it matches the item being claimed. If the Provider Type is already correct, check the patient's referral and DVA details next, as some items require a valid referral or DVA exemption details to be present. If neither resolves it, issue the patient an account receipt so they can claim through another channel, such as at a Medicare office.
9605 Another Medicare Card may have been issued to the patient, or the details entered do not match those held by Medicare. Update your records and resubmit the claim. Contact the patient to obtain their correct Medicare details.
9606 Another Medicare Card may have been issued to the claimant, or the details entered do not match those held by Medicare. Update your records and resubmit the claim. Contact the patient to obtain their correct Medicare details.
9624 A subsequent consultation has been keyed and the date of service is after the referral expiry date Get the patient's Medicare card number, item number and date of service, and contact Medicare for advice.
9625 Claimant address needs to be updated with Medicare. Issue an account/receipt for the claimant to submit via an alternative Medicare claiming channel. Ask the patient to check the address registered with Medicare, and amend the patient file. Once done, resubmit.
9628 Referral or request required Create a new invoice, add the referral, and submit.
9630 Check the request or referral details Check and amend the referral details as needed.
9631 Check if service self deemed Edit the invoice to indicate the service is self deemed, and re-submit.
9632 Duplicate of service already paid. If not a duplicate, resubmit with appropriate indication. Check the service dates.
9633 A new Medicare card has been issued. Update your records and ask the patient to use the new card number for any future claims. Contact the patient or Medicare for updated card details.
9634 A new Medicare card has been issued. Update your records and ask the claimant to use the new card number for any future claims. Contact the patient or Medicare for updated card details.
9635 Check Servicing Provider. May not be able to provide the service for this item at date of service Check the provider's registration dates, provider number validity, and eligibility to bill for this particular item.
9638 Claimant details required. Patient or quoted claimant is a minor. The claimant must be over 15 years old. List the parent or guardian on the same Medicare card.
9641 A restrictive condition exists Check the items being charged and review the rules on the MBS website, as they may be incompatible to bill with each other. If unsure, contact Medicare for advice.
9646 The claim could not be located by Medicare. The claim may have already been deleted. Contact Medicare for advice on re-submission of the claim.
9650 The card number and/or patient details submitted did not match Medicare's checks. Verify the details and resubmit with additional information if available. There is a verification issue between the patient details and Medicare's details. Check the details in the record, run an OPV check, and contact Medicare if needed.
9655 An LSPN is required Contact Medicare to apply for an LSPN (Location Specific Practice Number).
9656 LSPN invalid Contact Medicare to clarify your LSPN.
9662 Provider must contact Fund Check the provider and patient details with the fund, and re-submit the claim.
9666 Patient must contact Fund The patient must check their registered details with the fund.
9675 Current Medicare card has expired. The patient must contact Medicare, as claims using this Medicare card may be rejected. The patient's current Medicare details are not up to date. The patient will need to organise a new card.
9678 The service is not payable as an appropriate associated service is not present Review the MBS rules for the items involved, and re-do the claim.
9692 An Item Number must be supplied for every MBS service. Re-submit the claim with valid item numbers.
9699 Item not covered for this patient at this date of service The patient will need to check their eligibility with Medicare.
9700 An incorrect item number appears to have been used, or the amount claimed does not match the item number Check the claim and re-do it to ensure correct details. Once done, submit.
9705 In some instances where two or more services are performed together, they are claimable under one item number. Check the MBS for the correct item and re-submit. If exceptional circumstances exist, issue an account/receipt notating the reasons. Check the MBS for the correct item and resubmit. If exceptional circumstances exist, issue an account receipt and have the patient claim through an alternative channel, e.g. a Medicare office.
9765 Site not accredited for this service. The site must contact Medicare to check registration and eligibility.
No code identified Inconsistent treatment location in VCHR, claim separately. This occurs when the practice's Location Code (Minor Customer ID) used to transmit the claim doesn't match what's registered for the claiming channel (Medicare Online, ECLIPSE, DVA or AIR) being used. Check your Location Code at More > Settings > Configuration Settings, select the practice, then go to Claiming - PRODA. If you operate more than one practice location, confirm you're claiming from the correct one. If a new practice or Minor ID needs to be added to your PRODA device, contact MediRecords Support.

 

Error Specific Solutions

You can also view a list of errors and their relevant solutions in the Claiming Rejections & Errors section of the Knowledge Base.

For more information, visit the Department of Human Services website:

Medicare Digital Claiming Return Codes

Alternatively, you can contact Medicare Health Professional Online Services (HPOS) on 132 150 and select option 6 (Electronic Claiming including Online Claiming), or the eBusiness Service Centre on 1800 700 199 and select option 3 (Electronic Claiming including Online Claiming).

📌 Important: If you can't find your error code above, or the suggested fix doesn't resolve it, check the Claiming Rejections & Errors section for an article dedicated to that specific code, or contact MediRecords Support.

 

Further Reading

 

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Phone: 1300 103 903
Email: support@medirecords.com
Live chat: Available directly within the MediRecords app or via the Knowledge Base

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