It's possible for Medicare/DVA or the Health Fund to reject the services you have tried to claim, and this can happen for a number of reasons. Recognising rejections will help you in identifying what needs to be rectified before trying to re-submit the claim.
Scenario 1: The entire claim was rejected.
An entire claim may be rejected, and this will be immediately visible by checking the status of the claim in the In Progress section. 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, as well as a suggestion of what to rectify.
To re-submit an entire claim with a status of Rejected, firstly perform any recommendations that were in the rejection reason, then, tick the claim, and go to More > Re-Submit Claim.
Scenario 2: The service(s) was rejected.
If a claim in the In Progress section has remained in a status of Processed with an amount owing, it indicates one or more of the services within the claim require action. Tick the box next to the claim, then click View Services. Hovering your mouse over the description will show the entire reason as to what was missing or incorrect with that item or invoice.
When a service has not been paid, you have one of two options. You can either:
A) Re-submit the item to try again to get payment, with any necessary changes.
B) Accept the item, to accept that you're happy with non-payment, close the claim, and write off the invoice.
Option A: To re-submit an item(s), tick it, then click Re-Submit.
You will be asked whether you would like to create a new invoice for resubmission. You must always click Yes.
A copy of the invoice will be opened, and here you can make any necessary amendments Medicare had advised, such as adding the GP's referral. Once you are finished, click Claim.
The new invoice will be sent under a new claim number. The old invoice will be written off, and the original rejected claim will move to Claims Completed.
Option B: To accept the item, tick it, then click Accept Claim. This will move the claim to Claims Completed, and the original invoice will be adjusted (written off) in the patient's accounts section.
For more information about other errors and what actions to take, please contact the Department of Human Services - Medicare directly or refer to this page for information about specific return codes.