|This article is intended for the users of MediRecords.
If you are receiving these codes from claims transmitted outside of our software, or a patient with queries about a claim, please contact Medicare on 132 011
- All claims submitted to Medicare, DVA or Private Health Funds will be visible from claims circle 2 of 3 titled "In Progress"
- PCI Claims will be moved directly to claims circle 3 of 3 titled "Claims Completed this Week" as soon as the invoice has been finalised.
- PCS Claims will be visible from Claims circle 1 of 3 titled "Unclaimed Amount" until submitted.
- Once submitted, PCS claims will 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:
- A: Patient has successfully passed OPV (Online Patient Verification), OVV (Online Veteran Verification) or PVF (Patient Verification Fund) Checks, whichever is relevant to the claim type.
- B: Your MediRecords account has been successfully configured for Medicare claiming.
There are two types of codes involved in claiming: return codes and reason codes.
Return codes are 4 digit codes that given when there is an issue in the submission of the claim to Medicare. These codes are automatically generated by the gateway of the channel and generally indicate an issue with how the information is being 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 to identify any claiming errors, make corrections and potentially re-submit the claim(s). 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 eligibility of patients or health professionals to the need for extra details to assess the claim. There are 297 codes to date.
To help you with addressing rejected claims, we've put together a table of Return and Reason codes you may experience and steps you can take to address them.
Return Codes - 3 Digit Codes
|Code||Description||Steps to Resolve|
|253||Radiotherapy assessed with other item number on voucher||
Underpaid to the amount of $0 due to the item is rolled into base item.
|516||Benefit paid for base & derived radiotherapy items claimed||
Over payment on an item due to the derived item being paid with the base item.
|567||Benefit Paid on Main Diagnostic Imaging Service||Underpaid to the amount of $0 due to the item is rolled into base item.|
|Over payment on an item due to the derived item being paid with the base item.|
Return Codes - 4 Digit Codes
|Code||Description||Steps to Resolve|
|1006||PKI login failure.||Possible problem with PKI certificates installed. Certificates may have expired or another problem has been identified. Upload your PKI certificates once more. If error persists, contact Medicare directly|
|1007||Transmission failure.||Attempt to re-submit claim|
|1008||Medicare Online Claiming already operational||Sign out and sign back into MediRecords and attempt to submit|
|1703||Client Adaptor session does not exist||Re-submit the claim|
|1704||Desecure failure||Your connection to Medicare has been temporarily disrupted - please check the internet connectivity and/or submit again.|
|1705||Secure failure||Related to the certificates - please check with Medicare what has been uploaded|
|1712||HTTP server error||Refresh page Sign out and sign back into MediRecords Check internet connection (Recommended download speed is 18mbps) If problem persists, contact MediRecords Support on 1300 103 903 or email email@example.com|
|2016||No service exists in the claim for the supplied service ID||Please re-submit and ensure that 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. Please review and re-submit.|
|2032||The maximum number of services allowable for the voucher has been reached||The maximum amount of items to be claimed in one invoice in 14. Please submit another claim if exceeding this amount.|
|2038||The referral/request type is inconsistent with the service type set for this claim||Please check 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 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 status pages for Medicare, 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 RA number and HSS (Minor ID) number with Medicare is registered correctly for this site. Also check that practitioner Provider Numbers are registered correctly against the Minor ID number
|3029||HTTP redirection attempted||Check internet connection and try again.|
|3031||The server cannot fulfil this request||Check your internet connection. Also check Medicare status.|
|5010||The subscription ID supplied has been identified as in-active||Check if provider number of servicing practitioner is valid.|
|8005||The individual has been matched using the submitted data however differences were identified. Please check the information returned and update your records.||After 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.||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 servicing provider details, as they may not be eligible to provide service for this 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 practice and provider eligibility to bill for service - contact Medicare.|
|9119||The provider is identified as inactive for Online Claiming purposes. Contact the PKI Customer Service Centre for assistance.||Check provider registration with Medicare.|
|9120||The Individual Certificate used has been revoked by the Registration Authority. Contact 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 please contact Medicare.
|9201||Invalid format for data item||Some required information is missing or has been entered incorrectly. Please check all details being submitted.
Check 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 be due to patient details (e.g. address), the provider (e.g. provider number) and/or the item number(s) submitted. Please check all details and ensure no miscellaneous characters are used.
Check if you are using the correct billing schedule as that may cause this issue
|9204||Date in future. The date supplied must not be in the future||Please review service dates on claim and re-submit.|
|9301||Patient's Medicare card number must be supplied||Please check detail on patient file, run OPV check and re-submit.|
|9302||Patient's reference number must be supplied||Please check detail on patient file and re-submit.|
|9303||Patient's first name must be supplied||Please check detail on patient file and re-submit.|
|9304||Patient's family name must be supplied||Please check detail on patient file and re-submit.|
|9305||Servicing Practitioner's Provider Number must be supplied||Please check claim and provider number listed, and resubmit.|
|9306||Date of service must be supplied||Please check claim and re-submit.|
|9307||An item number must be supplied for each service||Please check item numbers on claim and re-submit.|
|9308||Referring Practitioner's Provider Number must be supplied||Please amend 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||Please check the referral/request date entered.|
|9310||Requesting Practitioner's Provider Number must be supplied||Please amend 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||Please 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 (5) must be supplied.||Please check all details listed on the patient file are listed correctly before re-submitting the claim again.|
|9316||The Referring/Requesting Provider cannot be the Servicing or Principal Provider||Please ensure the same provider is not listed for both, amend claim and re-submit.|
|9322||Referral period details must be supplied||Please 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 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||Please check detail on patient file, run 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.||Item is not covered for this patient at this date of service. Please raise new invoice and submit.|
|9601||Claim successfully transmitted and pended for further assessment by a Customer Support Officer. Claimant will be advised of outcome by mail.||Claim successfully transmitted and pended for further assessment by a Customer Support Officer. Claimant will be advised of outcome by mail|
|9602||This claim cannot be lodged through this channel. Please submit the claim via an alternative Medicare claiming channel.||Please issue patient an account receipt to claim through another channel e.g. at a Medicare office.|
|9605||Another Medicare Card may have been issued to the patient or the details you entered do not match those held by Medicare. Please update your records and resubmit the claim.||Please contact patient to obtain correct Medicare details.|
|9606||Another Medicare Card may have been issued to the claimant or the details you entered do not match those held by Medicare. Please update your records and resubmit the claim.||Please contact patient to obtain correct Medicare details.|
|9624||A subsequent consultation has been keyed and the date of service is after the referral expiry date||Get 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 account/receipt for the claimant to submit via an alternative Medicare claiming channel.||Get patient to check address registered with Medicare, and amend patient file. Once done, resubmit.|
|9628||Referral or request required||Create new invoice, add referral and submit.|
|9630||Please check the request or referral details||Check and amend referral details as needed.|
|9631||Check if service self deemed||Edit the invoice to indicate service self deemed, and re-submit.|
|9632||Duplicate of service already paid. If not duplicate resubmit with appropriate indication.||Please check the service dates. If same|
|9633||A new Medicare card has been issued. Please update your records and ask the patient to use the new card number for any future claims.||Please contact patient or Medicare for updated card details.|
|9634||A new Medicare card has been issued. Please update your records and ask the claimant to use the new card number for any future claims.||Please contact 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 provider registration dates, provider number validity and eligibility to bill for particular item.|
|9638||Claimant details required. Patient or quoted claimant is a minor.||Claimant must be over 15 years old. Please list parent or guardian on same Medicare card.|
|9641||A restrictive condition exists||Check the items being charged and review rules on MBS, 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.||Claim may have already been deleted. Please contact Medicare for advice on re-submission of claim.|
|9650||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. Please check the details in the record, run an OPV check and contact Medicare if needed.|
|9655||An LSPN is required||Please contact Medicare to apply for an LSPN.|
|9656||LSPN invalid||Please contact Medicare to clarify your LSPN.|
|9662||Provider must contact Fund||Please check provider and patient details with the fund, and re-submit claim.|
|9666||Patient must contact Fund||Patient must check registered details with the fund.|
|9675||Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected.||Current Medicare details for the patient are not up to date. The patient will need to organise for a new card.|
|9678||The service is not payable as an appropriate associated service is not present||Review MBS rules for items involved, and re-do claim.|
|9692||An Item Number must be supplied for every MBS service.||Please re-submit claim with valid item numbers.|
|9699||Item not covered for this patient at this date of service||Patient will need to check eligibility with Medicare.|
|9700||An incorrect item number appears to have been used/amount claimed does not match item number||Check claim and re-do 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. Please check the MBS for correct item and re-submit. If exceptional circumstances exist, please issue account/receipt notating reasons||Check the MBS for correct item and resubmit. If exceptional circumstances exist, issue an account receipt and get patient to claim through alternative channel e.g. Medicare office.|
|9765||Site not accredited for this service.||Site must contact Medicare to check registration and eligibility.|
Reason Codes - 3 Digit Codes
|101||More details of service required to assess benefit||Check failed item number on claim has required additional information to be assessed e.g After hours, not duplicate service|
|120||Age restriction applies to this item||Confirm patients recorded age has been stored correctly in MediRecords. If patients age is correct then patient is not eligible for this service item|
|125||Not payable without associated operation/anaesthetic item||Update claim to include associated operation/ anaesthetic item code. Update claim and re-submit|
|136||Referral details not supplied- paid at g.p. rate||Check billing providers Medicare Provider Type from users preferences and that '"Include Referral for Medicare billing" has been checked to ensure future claims are assessed at the appropriate rate|
|141||No benefit payable for services performed by this provider||Provider may not be eligible to bill item, or need to renew registration with Medicare.|
|157||Service possibly aftercare - refer to provider||Please check the type of service given by the provider, 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 such as the service is not performed on the same occasion, not associated with the other service, not performed through the same incision, then for:
|162||Benefit has been previously paid for this service||Medicare is viewing this service as a duplicate. Please follow the Managing Rejections article on 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||Please review the MBS rules regarding the item(s) and ensure that associated service items are included in re-submission.|
|307||Claim not paid - cardnumber not valid for date of service||Patient needs to check with Medicare for valid card details. Practice to update patient record with correct details for submission.|
|377||Number of patients seen not indicated||Re-submit claim(s). If still rejected, contact MediRecords.|
|412||Benefit not payable - provider unable to claim this service||Please check provider registration with Medicare and eligibility to bill item(s).|
|434||Expired or invalid card. benefit not payable||Patient needs to be re-issued new card details from Medicare.|
|502||Patient is not eligible to claim benefit for this item||Patient must check their eligibility with Medicare regarding the item services billed.|
|507||Site not accredited for this service||Please contact Medicare to check your minor site ID and other practice registration details.|
|516||Been 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||Please ensure you re-submit the claim as a bulk billing service.|
|529||Bulk bill additional item claimed incorrectly||The items that are claimed together are not following eligibility rules. Please review the rules listed for the item on the MBS website.|
|536||Location specific practice number not supplied||Remove all Duration of Service information for all items in the invoice, and submit again.|
|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 referring/requesting provider for valid details.|
|607||Referral date has been omitted||Check and amend referral details.|
|616||Item cannot be claimed as in hospital service||Please review item(s) rules on the MBS website.|
|617||Item cannot be claimed as out of hospital service||Please review 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 item rules on MBS, raise invoice and include appropriate items.|
|714||Benefit not determined - number ot time units not present||Check the information being submitted, amend and re-submit. If this persists, contact MediRecords.|
|732||Referral period not valid for referring provider||Please check the dates with the referring provider as a new referral may need to be issued.|
If you'd like to know more, please visit the department of human services website using the link below:
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).
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