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Troubleshooting DVA claims

Error codes on DVA claims

Updated over a week ago

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

This article includes:

1. How to troubleshoot the DVA claim
2. Most common error codes from DVA

How to troubleshoot the DVA claim

1. From the client's file, click on Invoicing 
2. You can now view any error codes from the status column or, You can hover over the Actions button on the relevant invoice and select DVA Medical/DVA Allied Health depending on your claim type
3. Use your error code to create a new invoice with the correct details and then submit it to Medicare.

💡 Please, note that due to the transition to PRODA resubmitting invoices is not possible anymore. If a claim has been rejected by Medicare, you'll have to recreate the invoice and submit it again.

💡 You can find claims that have been rejected by running the Claim Status Report (Reports > Medicare > Claim Status)

Most common error codes from DVA

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;

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 the Medicare processing line on 132 150 to confirm if the invoice has actually been paid. If not, create a new invoice and then submit it to Medicare, and in a few days check the Medicare report to see if the claim has been processed

108: Item claimed not payable at date of service

​This means DVA has determined they can not pay for this item at the specified date. You may need to contact DVA for more information

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.

Action: Create a new invoice and ensure that the Start date, Referring Period, and referring provider number are all entered in.

159: Item associated with other service which is payable

This usually means you cannot claim for this service until another item number has been claimed. You may need to contact DVA to determine what item needs to be claimed.

255 - Benefit assigned has been increased

The Medicare/DVA benefit schedule has changed, and as a result, the item codes benefit has increased.

Action: You can adjust your item code fees within the Setup > Settings > Service Types and create a new invoice, and then submit it to Medicare.

526: Item only attracts a benefit when claimed through Medicare.

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

578: Item number cannot be determined from information supplied

​This means DVA doesn't know what item you're claiming for.

Action: You may need to check that the item number is correct (including any letters required).

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 in the invoice.

Action: Create a new invoice and for Accepted Disability select Yes, and supply further information in all capital letters within the Accepted Disability Text field.

642: Benefit paid for derived and other item claimed & 643: Derived item assessed with other item on statement

This combination of errors means that Medicare has not paid a rebate for the 'derived item', but instead they've paid an extra amount for the other item claimed. This error usually means that the claim has been paid and no further action is needed.

654: Item transmitted via incorrect online claiming channel

This usually means you have selected the wrong channel for your DVA claim.

Action: Make sure you have selected DVA Allied Health in the Medicare claim menu. If you have Selected DVA Medical, you will need to recreate the invoice using the correct Allied Health channel.

💡 The full list of possible Medicare error codes can be found below:

DVA reason codes - DVA Reason Codes

The 4 digit codes (DB4 - Client) - 4 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.

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