In certain cases, the claims you submit through Medicare may not be successful. However, the system is designed to flag these claims with error codes to give you as much information as possible on why the claim was rejected, as well as clues on how to fix.
This article will detail common scenarios that will display in the Claiming dashboard (Accounts > Claiming).
Claims that are rejected will display the error message in one of two ways:
Hovering on the (i) icon.
Opening a claim by clicking View Service, and viewing the Description.
Below is a list of common rejection scenarios, along with a brief explanation.
Benefit has been previously paid for this service - Medicare is viewing this service as a duplicate.
The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available - there is a verification issue between patient details and Medicare details.
Bulk bill additional item claimed incorrectly - the items that are claimed together are not following eligibility rules.
Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected - The patient card details will need to be updated.
Invalid value for data item. The data element does not comply with the values permitted or has failed a check digit check - there are issues with the data being sent to Medicare for that claim, which may be due to patient details (e.g. address), the provider (e.g. provider number) and/or the item number(s) submitted.
Invalid format for data item - Some required information is missing or has been entered incorrectly.
For strategies on how to manage these rejections, please refer to the support article Managing Rejections.
For a more comprehensive list of Medicare rejection scenarios, please see the following link: Education guide - Medicare reason codes and reducing claim rejections.
For a more comprehensive list of DVA rejection scenarios, please see the following link: DVA reason codes.
You've completed another MediRecords Tutorial. You should now be able to view the various rejection scenarios with affected claims. 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.