Medicare Error Codes

Claims can occasionally get rejected by Medicare. When this happens, Medicare will respond with an error code that can help in diagnosing what needs to be corrected in order to submit the claim successfully.

 

You can find claims that have been rejected by running the Claim Status report

 

The necessary steps to find your error codes and the accompanying explanation text can be found below.

 

Step 1 - Navigate to the client from the Client List (Or search field)

 

Step 2 - Select Invoicing from the sidebar

 

Step 3 - Hover over the Actions button on the relevant invoice and select Bulk Bill/Patient Claim/Department of Veteran Affairs (Known within coreplus as BB/PCI/DVA) depending on your claim type

 

Step 5 - Click View Report

 

Step 6 - The error code will be listed on either the Client or Processed tabs

 

Examples of each are below:

DB4 - Client

 

DB4 - Processed 

 

Step 7 - Once you have your error code you will need to look it up from Medicare list of error codes.

The 4 digit codes (DB4 - Client) can be found here; 4 Digit Codes

The 3 digit codes (DB4 - Processed) can be found here; 3 Digit Codes

(These will be downloaded as a .csv file and can be opened in Microsoft Excel)

 

Step 8 - Use your error code to correct your claim and click the re-submit button

(Click here for more information on re-submitting)

 

Some common error codes and explanation can found below:

"8005=The individual has been matched using the submitted data however differences were identified. Please check the information returned and update your records."

Some of the clients details (Name, Address, etc.) must be updated to match Medicare's files before the claim will be accepted.

 

"9617=The referral has expired"

The referral is no longer valid and will not be accepted.

 

"9616=The BSB supplied is invalid, unknown or cannot be used for Medicare payments"

Check the clients bank details on the claim before re-submitting"

 

"9650=The card number and/or patient details submitted did not match Medicare Australia's checks. Please verify the details and resubmit with additional information if available."

The clients card number and/or address must be updated to match Medicare's files before the claim will be accepted.

 

"9655=An LSPN is required"

The LSPN must be entered using the Flags button on the invoice.

 

"9675=Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected."

Client's Medicare card has expired.

 

"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."

Client has been issued a new Medicare card. Contact client to update details and re-submit.

 

"9701=The maximum number of services for this item have been paid, if this service is not a duplicate please resend with correct item numbers as per MBS"

Client has already claimed the maximum number of services for this item.

 

"162=Service has been previously paid" 

The rebate for this service has already been paid. This may have likely occurred because the invoice was submitted to Medicare more than once.

 

"581=Condition treated has not been stated"

Accepted Disability Text has not been filled out for this claim/invoice.

 

"526=Item only attracts a benefit when claimed through Medicare."

Claim has incorrectly been submitted as a DVA claim rather than bulk bill or patient.

Lachlan Cox -

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