When Lodging a claim through Medicare return error codes tell you why the claim has been rejected.
| 101 | More details of service required to assess benefit | |
| 102 | No amount charged is shown on account/receipt | |
| 103 | Letter of explanation is being sent separately | |
| 104 | Balance of benefit due to claimant | |
| 105 | Benefit paid to provider as requested | |
| 106 | Servicing provider unable to be identified | |
| 107 | Benefit paid on item number other than that claimed | |
| 108 | Benefit is not payable for the service claimed | |
| 111 | No benefit payable - claims/s over 2 years old | |
| 113 | Total charge shown on account apportioned over all items | |
| 115 | Benefit recommended for this item | |
| 117 | Benefit not recommended for this item | |
| 120 | Age restriction applies to this item | |
| 122 | Associated referral/request line not required | |
| 123 | Benefit paid on radiology item other than service claimed | |
| 124 | Item is restricted to persons of opposite sex to patient | |
| 125 | Not payable without associated operation/antiesthetic item | |
| 126 | Service is not payable without radiology service | |
| 127 | Maximum number of additional fields already paid s | |
| 128 | Benefit paid on associated fracture/amputation item | |
| 129 |
Service is not payable without the base item/s- The GP may not have submitted the referral information to Medicare, or has submitted the incorrect referral information to Medicare. Check the details above are correct. If they are, wait two days and reprocess the claim again. If the claim still cannot be processed, contact Medicare on 13 32 54. |
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| 130 | Letter of explanation is being sent separately | |
| 131 | Date of service not supplied/invalid | |
| 134 | Single course of treatment paid as subsequent attendance | |
| 135 | Provider not a consultant physician - specialist rate paid | |
| 136 | Referral details not supplied- paid at g.p. rate | |
| 137 |
Details of requesting provider not shown on account/receipt The details of the referral provider were not included on the invoice when submitted. Update the referring provider's details |
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| 138 | Benefit only payable when self-determined/deemed necessary | |
| 139 | Approved pathologist should not use this item number | |
| 140 | Non-specialist provider | |
| 141 |
No benefit payable for services performed by this provider The provider number and item number are not eligible to be claimed together. Choose a different fee for this service and reprocess the claim |
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| 142 | Letter of explanation is being sent separately | |
| 144 | Claim benefit not paid - further assessment required | |
| 150 | Member has not supplied details to permit claim payment | |
| 151 | Associated service already paid-adjustment being processed | |
| 154 | Diagnostic imaging multiple service rule applied to service | |
| 155 | Letter of explanation is being sent separately | |
| 157 | Service possibly aftercare - refer to provider | |
| 158 | Benefit paid on associated abandoned surgery/anae item | |
| 159 |
Item associated with other service on which benefit payable You cannot claim for this service until another item number has been claimed. |
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| 160 |
Maximum number of services for this item already paid Medicare only allows a certain number of services per referral and the patient has exceeded these. You will need to either ask the patient for another referral, or call Medicare on 132 150. |
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| 161 | Adjustment to benefit previously paid | |
| 162 |
Benefit has been previously paid for this service If the claim is correct, reprocess the claim and add explanation text in the Additional Information field (you may need to check with Medicare to confirm what is an acceptable reason). Click Process when you are done. The additional information will be flagged for someone to check at Medicare. |
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| 163 | Surgical/anaesthetic item/s already paid for this date | |
| 164 | Assistant surgeon benefit not payable | |
| 166 | Letter of explanation is being sent separately | |
| 168 | Not payable without associated operation/anaesthetic item | |
| 169 | Operation/anaesthetic item not claimed | |
| 170 | Assistant anaesthetic benefit not payable | |
| 171 | Benefit not payable - provider may only act in one capacity | |
| 173 | Patient episode coning - maximum number of services paid | |
| 174 | Patient episode coning adjustment | |
| 175 | Benefit paid on associated foetal intervention item | |
| 176 | Pay each foetal intervention item as a separate item | |
| 177 | Foetal intervention item paid using derived fee item | |
| 179 | Benefit not payable - associated service already paid | |
| 184 | Benefit paid for additional time item using a derived fee | |
| 194 | Letter of explanation is being sent separately | |
| 195 | Letter of explanation is being sent separately | |
| 206 | Item number does not attract a benefit at date of service | |
| 208 | Card number used has expired | |
| 209 | Claimants name stated is different to that on card number | |
| 211 | Patient not covered by this card number at date of service | |
| 212 | Date of service used is in the future | |
| 214 | Claim form not complete | |
| 215 | Service claimed prior 1 February 1984 | |
| 217 | Patient cannot be identified from information supplied | |
| 222 | Benefit paid on associated anaesthetic item | |
| 223 | Service not payable - specified item not claimed or present | |
| 225 | Patient contribution substantiated-additional benefit paid | |
| 226 | Date of service is prior to patients date of birth | |
| 227 | Date of service prior to date eligible for Medicare benefit | |
| 228 | Date of service after benefit period for overseas visitor | |
| 229 |
Benefit paid at 100% of schedule fee Due to the patient reaching the Medicare safety net, they have been paid more than the scheduled fee. No action is required. |
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| 230 | Combination of 85% and 100% of schedule fee paid | |
| 232 | Service claimed not covered by Medicare | |
| 233 | Provider not entitled to Medicare benefit at date of service | |
| 234 | Letter of explanation is being sent separately | |
| 236 | Letter of explanation is being sent separately | |
| 237 | Letter of explanation is being sent separately | |
| 238 | Not paid because all associated services rejected | |
| 240 | Gap adjustment to benefit previously paid | |
| 241 | Total charge and benefit for multiple procedure | |
| 242 | Service is part of a multiple procedure | |
| 243 | Apportioned charge and total benefit for multiple procedure | |
| 244 | Benefit not paid - service line in error | |
| 245 | Benefit paid on service other than that claimed | |
| 246 | Patient cannot be identified from information supplied | |
| 250 | Explanation/voucher will be forwarded separately | |
| 251 | Details of requesting provider not supplied | |
| 252 | Service possibly aftercare | |
| 253 | Radiotherapy assessed with other item number on statement | |
| 254 | Assessment incomplete - further advice will follow | |
| 255 | Benefit assigned has been increased | |
| 256 | Benefit not payable on this service for a hospital patient | |
| 260 | Benefit assessed with associated item on statement | |
| 261 | Associated surgical items/anaesthetic time not supplied | |
| 262 | Insufficient prolonged anaesthetic time - service not paid | |
| 264 | Benefit not payable - compensation/damages service | |
| 265 | Service not covered by reciprocal health care agreement | |
| 267 | Service not payable - associated service not present | |
| 271 | Not payable without associated ophthalmological item | |
| 272 | Benefit paid on associated ophthalmological item | |
| 274 | Provisional payment | |
| 280 | Cannot identify service. resubmit with correct MBS item | |
| 282 | Date of service outside of referral/request period | |
| 306 | Card# not valid at date of service-future claims may reject | |
| 307 | Claim not paid - card number not valid for date of service | |
| 308 | Ivf service - conditions not met - no benefit payable | |
| 316 | Benefit not payable - item cannot be self-determined | |
| 317 | Benefit not payable - additional item to those requested | |
| 320 | Quoted Medicare card number is incorrect | |
| 322 | Provider not approved for this Medicare pathology benefit | |
| 325 | Laboratory not accredited for benefits for this service | |
| 326 | Laboratory not accredited for benefits at date of service | |
| 328 | Benefit paid on associated tomography item | |
| 329 | Not payable without associated tomography item | |
| 331 | Benefit not payable - h.i. act sect 20(a)(1) | |
| 332 | Category 5 lab - benefit not payable for requested service | |
| 333 | Provider must claim time-based items | |
| 334 | Benefit not payable-associated pathology must be inpatient | |
| 335 | Service is not payable without nuclear medicine service | |
| 336 | Benefit paid on nuclear medicine item other than one claimed | |
| 337 | Provider must claim content-based items | |
| 338 | Provider not registered to claim benefit at date of service | |
| 339 | Benefit paid at the concession rate | |
| 340 | Refund of co-payment amount | |
| 341 | No referral details - details required for future claims | |
| 342 | Referral expired - paid at unreferred (gp) rate | |
| 343 | Card number quoted on claim form has been cancelled | |
| 344 | Concession number invalid - benefit paid at general rate | |
| 345 | No safety net entitlement - benefit paid at general rate | |
| 346 | Co-payment not made - $2.50 credited to threshold | |
| 347 | Safety net threshold reached - benefit increased | |
| 348 | Overpayment of claim - invalid concession number | |
| 349 | Replacement for requested eft payment rejected by bank | |
| 350 | Hospital referral - paid at specialist/consultant rate | |
| 351 | Benefit not payable - lcc number incorrect or not supplied | |
| 352 | Service date outside lcc registration dates | |
| 353 | Pathology items not present - no benefit payable | |
| 356 | Documentation required to process service | |
| 358 | Documentation not received - unable to process service | |
| 359 | Documentation not received - unable to process claim | |
| 360 | No benefit payable when requested by this provider | |
| 361 | Di exemption/items not approved | |
| 364 | Items claimed must be as a combination item | |
| 367 | Service associated with mbac item in a multiple procedure | |
| 370 | Benefit paid on item number other than that claimed | |
| 371 | Future claims quoting old style card no. will be rejected | |
| 372 | Old style card number quoted - benefit not payable | |
| 373 | Expired card - benefit not payable | |
| 374 | Old card issue used - benefit not payable - also refer @ | |
| 375 | Service being processed manually | |
| 377 | Number of patients seen not indicated | |
| 378 | Provider cannot refer/request service at date of request | |
| 390 | Documentation not received | |
| 391 | Service provider on db1 differs from transmitted data | |
| 392 | Benefit amount changed | |
| 393 | No benefit payable - baby not an admitted inpatient | |
| 395 | Tac medical excess | |
| 400 | Equipment number missing or invalid | |
| 401 | Benefit not payable - charge amount missing or invalid | |
| 402 | Benefit not payable- number of patients attended required | |
| 403 | Subsequent consultation - referral details required | |
| 404 | Benefit not payable - referral/request details required | |
| 405 | Equipment number invalid for servicing provider | |
| 406 | Unable to assess claim - please forward documents | |
| 407 | Benefit not payable - overseas student | |
| 408 | Date of service prior to 29 may 1995 | |
| 409 | Cardnumber for this enrolment needs to be verified | |
| 410 | Age restriction applies for this item - verify details | |
| 411 | Mbac determination/precedent number not supplied or invalid | |
| 412 | Benefit not payable - provider unable to claim this service | |
| 413 | Benefit not payable - date of serv prior to date of request | |
| 414 | Provider practice location is closed at date of service | |
| 415 | Referral details same as rendering provider - self-deemed? | |
| 416 | Services form a composite item - composite item required | |
| 417 | Referral needed - if no referral, nr item to be transmitted | |
| 418 | Item cannot be claimed more than once in one attendance | |
| 419 | Benefit already paid on item - verify if multiple pregnancy | |
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9006 |
The provider is not authorised to participate in online claiming The Provider Number/Location ID used for the claim is not registered for online claiming in PRODA. Check that the you have completed registration for Medicare online claiming and ensure you have requested and activated your Location ID. The Provider Number and the Location ID you want to use to claim must be registered together using the same form. |
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| 9007 |
The location is not authorised to undertake the function on the date of transmission The Location ID used for the claim has not been activated. Complete all the steps in registering for online Medicare claiming. |
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