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.
137: Details of requesting provider not shown on account/receipt
Details of the referral provider were not included on the invoice when submitted.
Action: unlock the invoice and under Referral \ Request information ensure there is a start date, Referring Period and provider number entered.
160: Maximum number of services for this item already paid
This means that Medicare has already paid the maximum number of item for the current referral or for the year.
Action: Seek a new referral for your client and add the referral to your client's file. Make sure to update the invoice with the new referral details.
162: Benefit has been previously paid for this service
The rebate for this service has already been paid. This may have likely occurred because the invoice was submitted to Medicare more than once.
Action: Contact Medicare processing line on 132 150 to confirm if the invoice has actually been paid. If not, re process the claim and in a few days check the Medicare report to see if the claim has been processed
255: Benefit assigned has been increased
The Medicare/DVA benefit schedule has changed, and as a result the item codes benefit has increased
Action: Confirm the correct amount on the Medicare MBS then you can adjust your item code fees within the Setup > Settings > Service Types area of coreplus and re process the claim
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.
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.
Action: Make sure the consultation date, date of birth or referral start date are not in the future
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
This usually mean there's an issue with the referral or consult date.
Action: Check the date of the referral, the date of the consult, and the client's birthdate to ensure the referral is dated before the consult and the referral and consult dates are after the date of birth. For 12 month referrals, check that the consult date is no more that 12 months after the referral date.
9342: The Payee Practitioner supplied is the same as the Servicing Provider
This means that servicing provider number (in Consultation Information) is different to the payee provider number (in Claim Information), but the two different provider numbers belong to the same person. This usually occurs when your Medicare defaults are set so that one particular provider number is the payee provider for all claims.
Action: To process your claim simply change the payee provider number to match the servicing provider number.
💡 If you can't see Payee Provider Number option in Claim Information on the invoice, you'll need to check 'User can change this when claiming' under Principal Provider Number (payment directed to) for the relevant claim type in your claiming defaults
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.
Action: Advise the client of the above and they will either need to wait for the outcome or contact Medicare directly.
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)
Check that Service Category is set to Specialist and you have selected the correct Medicare claim type.
Action: Advise the client their claim cannot be lodged through online claiming, print their invoice to claim at a Medicare branch directly.
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.
Action: 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.
9617 - The referral has expired.
The referral is no longer valid and will not be accepted.
Action: Either seek another referral or if appropriate, update their current referral with new dates
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.
9625 - Claimant address needs to be updated with Medicare, Issue account/receipt for the claimant to submit via an alternative Medicare claiming channel.
Action: 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.
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.
Action: If you cannot find the original claim, contact Medicare on 132150.
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.
Action: If you can still not re process the claim, try creating a new invoice with the updated Medicare details and then deleting the old invoice
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.
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.
Action: 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.
Actoin: 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.
Action: Obtain a new referral or contact Medicare directly.
📝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.
📝 For DVA error codes see Troubleshooting DVA claims