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 (Reports > Medicare > Claim Status)
The necessary steps to find your error codes and the accompanying explanation text can be found below.
1. From the client's file, click on Invoicing
2. You can now view any error codes (and even payment run information!) right from the status column
You can hover over the Actions button on the relevant invoice and select Bulk Bill/Patient Claim (Known within coreplus as BB/PCI) depending on your claim type
3. Use your error code to correct your claim and click the re-submit button
📝Our guide on re-submitting can be found here
What do I do now?
Understanding what these responses and messages mean can sometimes be tricky.
So, below is a glossary of the more common messages from Medicare as well as what needs to be done in order to re-submit the claim successfully;
The signing location is unknown
The 'signing location' error can usually be resolved by waiting 3 to 5 seconds or so and then resubmitting the claim to Medicare/DVA.
The error is usually caused by a temporary connection issue with the Medicare servers due to a high amount of claims they're trying to process.
9633/9634 - A new Medicare card has been issued. Please update your records and ask the patient/claimant to use the new card number for any future claims.
You are able to run a OPV to retrieve the patient/claimants new Medicare card number, this can be done by following the link here.
9632 - Duplicate of service already paid. If not duplicate resubmit with appropriate indication.
This error relates to the claim being sent to Medicare multiple times, and was rejected as the first successful submission was paid and processed.
9641 - A restrictive condition exists.
The restrictive condition exists error relates to an issue between the patient and Medicare, typically it will require the patient to take the claim into a Medicare branch, however it'd be worth confirming the following are all correct:
- Patient's details are all up to date and valid (E.g name, d.o.b, Medicare card number).
- Item code is correct, referral details are all listed and are valid.
If all the above are correct and the 9641 error code is still being received, the claim will need to be printed out for the patient to take into a Medicare branch.
9602 - This claim cannot be lodged through this channel. Please submit the claim via an alternative Medicare claiming channel.
This error can relate to a few different issues, firstly confirm the following are all correct.
- Patient info such as name, D.O.B, address, and Medicare card number are all correct.
- Claim information is all correct, such as service type, date of service, and provider number.
- Ensure the referral details are listed and are all correct (if the patient has a referral).
If all the above are correct and that error code is still being received, the patient will need to take their claim into a Medicare branch.
9625 - Claimant address needs to be updated with Medicare, Issue account/receipt for the claimant to submit via an alternative Medicare claiming channel.
The claimants physical address will need to be updated with Medicare, you will need to print the claim out and have the patient take it into a Medicare branch.
9605/9606 - Another Medicare Card may have been issued to the patient/claimant or the details you entered do not match those held by Medicare. Please update your records and resubmit the claim.
Verify that the patients Medicare card number, first name, last name, and D.O.B are all correct and up to date, you can do this by running a Medicare OPV.
9601 - Claim successfully transmitted and pended for further assessment by a Customer Support Officer. Claimant will be advised of outcome by mail.
This is an error between the patient & Medicare, as the patient cannot have their claims automatically processed.
9204 - Date in future. The date supplied must not be in the future.
The consultation date, date of birth, and or referral start date are in the future.
8005 - The individual has been matched using the submitted data however differences were identified. Please check the information returned and update your records.
One or more of the clients details (Name, Address, D.O.B etc.) must be updated to match Medicare's files before the claim will be accepted.
You are able to confirm what is incorrect by running a Medicare OPV.
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. You can check your clients Medicare details by running a Medicare OPV.
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. You can check your clients Medicare details running a Medicare OPV.
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, this can be found under the 'Client Information' area, for accepted disability select Yes, and supply further info within the Accepted Disability Text field.
137 - Details of requesting provider not shown on account/receipt
The referring doctor/GP's details were not listed on the invoice, this should be just under Referral \ Request Information, ensure that the Start date, Referring Period, and referring provider number are all entered in.
255 - Benefit assigned has been increased
The Medicare/DVA benefit schedule has changed, and as a result the item codes benefit has increased, you can adjust your item code fees within the Setup > Settings > Service Types area of coreplus.
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.
📝The full list of possible Medicare error codes can be found below:
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)
You can call Medicare's processing line on 132 150 for further assistance with rejected claims. You are also welcome to contact our Customer Service Team.