Managing Rejections

Managing Rejections

When a claim is rejected, this is immediately visible within Medirecords as the claim will have it's text in red. This is the same with any other record - when the record is highlighted in red, it requires action. 

This is immediately visible from the Claiming window (Accounts > Claiming)

MediRecords returns the error codes and reasons that Medicare assigns each claim; this is visible at a glance by hovering over the Information Icon (i) on the claim record.

To see the details of a claim and the associated services, click the Tick-box next to the claim, and click View Services.

The claim details displays a summary of the service or services associated with the claim. The Status displays which services have been Fully Paid, and which are Unpaid.

Claims can be rejected or unpaid by Medicare for a number of reasons. The most common reason is "Benefit has been previously paid for this service", which means that Medicare detected that a claim has already been paid for the same or similar service in the last 24 hours.

In the example above, the claim has been rejected and unpaid due to a duplicate service on the same day.  

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.

When a claim is rejected, it needs to be re-submitted to Medicare with additional information.
To re-submit a claim, click the Tick-box next to the name to reveal additional options. Click Open Invoice to open the original claim invoice for editing.  



When the invoice form opens, hover your mouse over the left-hand side of the line of the invoice that been rejected. When the cursor turns into a Finger-Pointer, a Pen Icon will appear.

Click the Pen Icon to edit the individual line of the invoice.

In the case of Medicare rejecting the claim due to a duplicate service, when the Edit Item form opens, click the Not a Duplicate Service tick-box. Also add the exact Time of the Service, and some additional Comments.

Click Save to apply the changes and return to the invoice form.

Click Update to apply the changes to the invoice, and you will be returned to the Claim Details.

(An updated Medicare claim form may open in a new tab where it can be printed).

You will now need to re-submit the claim to Medicare, with the updated details about the service. 

Click the Tick-box next to the name to reveal additional options. Click Re-Submit to move the invoice item back to the Unclaimed Amount module, where it can be re-submitted to Medicare, as part of a standard batch submission process.  

You've completed another MediRecords Tutorial. You should now be able to see rejected Medicare claims and find the reason behind them if supplied. If this is not what you're looking for, head back to our knowledge base and search for another article.

For urgent assistance, please contact MediRecords support on 1300 103 903 during business hours.