1005

Facility ID not known to fund

The Facility ID (hospital's Medicare provider number) is not current or not registered at the health fund.

Check the Facility ID. If it is incorrect, lodge the claim with the correct Facility ID. If it is correct, contact the health fund.

1008

EFT Details have not been registered with fund

1100

Not eligible for selected service

The patient is not eligible for the service/s in the claim.

1102

Eligible subject to conditions

2006

Benefit not payable for services claimed

2009

Benefit not payable under this level of cover

2016

Benefit for this service has been previously paid

2030

Billing Agent Provider Number must be supplied if Claim Type Code is MB or MO.

This could mean that the claim is meant for Medicare in-patient claim. Process the claim by submitting it as bulk bill instead. Follow the instructions from Process Medicare in-patient claim help guide.

2500

Certificate has not been provided

2501

Claim Held For Review

2502

Claim held during Contract Change

2503

Benefit Paid At Contract Rate

2504

Date validation failed. Check all dates submitted in claim

2505

Bed Level selected is not accepted by Fund

2506

Incorrect Charge Amount

2507

Incorrect Service Code or DRG supplied

2508

Incorrect Service Code Type selected

2509

Incorrect Charge Indicator Set

2510

Claim charged as Casemix Episodic Payment instead of Fee For Service

2511

Claim charged as Fee For Service instead of Casemix Episodic Payment

2512

Claim held for Accident Certificate or PEA

2513

Continuous Episode. Please Adjust Original Claim

2514

Duplicate Date Of Service

2515

Incorrect Patient Classification

2516

Health Fund does not accept Adjustment Claims. Submit paper claim

2517

Original Claim not found. Adjustment claim cannot be processed.

2518

Supplementary claims should only contain prosthetic or miscellaneous items

2519

Invalid data sent

2520

Reduced benefit as per member level of cover

2521

Non-DRG Morbidity data has not been supplied

2522

Transport charges not accepted by this Fund

2523

Medical Services not accepted by this Fund

2524

Service code required

2525

Private room add-on error

2526

ICU or Ventilation Hours must be supplied

2527

Interim claims cannot be accepted by Fund. Send paper claim.

2528

Theatre details must be supplied

2529

New Born addition to membership cannot be actioned automatically by Fund

2530

Fund specific information message

2531

Re-admission within 7 days. Please check charges.

2532

Original accommodation claim not found. Supplementary claim cannot be accepted

2533

Claim paid at Nursing Home Type Patient rates

2534

Benefit Limitation Period applies

2535

Supplementary claim cannot be accepted by Fund

2536

Manual review of original claim done. Adjustment cannot be processed

2537

Date of service older than agreed contract submission date

2538

Claim does not meet contract agreement for electronic claiming

2999

Processing error. Contact fund.

9999

Claim rejected refer to individual service line assessments for reason