Troubleshoot Medicare error codes

10

Invalid

The provider number is not linked to a bank account. Contact Medicare.

129

Service is not payable without the base item/s

The GP may not have submitted the referral information to Medicare, or has submitted the incorrect referral information to Medicare. Check the details above are correct. If they are, wait two days and reprocess the claim again. If the claim still cannot be processed, contact Medicare on 13 32 54.

137

Details of requesting provider not shown on account/receipt

The details of the referral provider were not included on the invoice when submitted. Update the referring provider's details:

141

No benefit payable for services performed by this provider

The provider number and item number are not eligible to be claimed together. Choose a different fee for this service and reprocess the claim.

159

Item associated with other service on which benefit payable

You cannot claim for this service until another item number has been claimed.

160

The maximum number of services for this item has already been paid

Medicare only allows a certain number of services per referral and the patient has exceeded these. You will need to either ask the patient for another referral, or call Medicare on 1800 700 199.

162

Benefit has been previously paid for this service

If the claim is correct, reprocess the claim and add explanation text in the Additional Information field (you may need to check with Medicare to confirm what is an acceptable reason). Click Process when you are done. The additional information will be flagged for someone to check at Medicare.

After a few days, run a Medicare Claims report to confirm if the reprocessed claim has been paid:

If the claim has not been paid, you need to undo the payment and start again. To do this:

If the claim has still not been paid, you may wish to change the fee to a private fee.

Alternatively, the claim may not have been paid due to actions taken by the patient. Please contact Medicare if you are still unsure what to do.

229

Benefit paid at 100% of schedule fee

Due to the patient reaching the Medicare safety net, they have been paid more than the scheduled fee. No action is required.

230

Combination of 85% and 100% of schedule fee paid

Due to the patient reaching the Medicare safety net, they have been paid between 85% and 100% of scheduled fee. No action is required.

267

Service not payable - associated service not present

Medicare will not pay this specific item without another associated item in the claim. Check the invoice and add the second service that must be claimed with this claim.

279

Prior approval not sought or advice of admission not lodged

Approval must be sought from Medicare before this claim can be processed. Contact Medicare on 1800 700 199.

320

Quoted Medicare card number is incorrect

The Medicare card number entered into Halaxy is incorrect. Verify the patient's Medicare card number by performing an Online Patient Verification.

If the verification is successful, the icon changes to a Verified icon and you can reprocess the claim.

If verification is unsuccessful, Medicare provides you with a message saying why the details are not correct so you can obtain the correct Medicare details from the patient.

374

Old card issue used - benefit not payable

The patient's Medicare card is expired and needs to be updated, followed by an Online Patient Verification on the patient's profile (Funding tab). If there is still a problem, contact the patient or call Medicare on 1800 700 199.

377

Number of patients seen not indicated

The number of patients seen has not been entered on the invoice.

378

Provider cannot refer/request service at date of request

The referring practitioner has not provided Medicare with details of the referral. You should speak to the referring practitioner, who will need to forward the referral to Medicare.

511

Emsn threshold reached - cap applied to benefit

Due to the patient reaching the extended Medicare safety net, a cap has been applied to their payment. No action is required.

517

Mpsn threshold reached - 80% out of pocket paid

The maximum patient safety net of 80% out of pocket has been reached. This means the patient has been paid more due to the Medicare safety net. No action is required.

518

Benefit paid at 100% schedule fee + emsn

Due to the patient reaching the extended Medicare safety net, they have been paid more than the scheduled fee. No action is required.

519

Mpsn threshold reached - partial 80% out of pocket paid

Due to the patient reaching the Medicare safety net, they have been paid more than the scheduled fee. No action is required.

522

Benefit paid - emsn + between 85% and 100% schedule fee

Due to the patient reaching the Medicare safety net, the benefit paid is between 85% and 100% of the scheduled fee. No action is required.

550

Associated service not claimed - no benefit payable

The referring provider may not have submitted the referral information to Medicare, or has submitted the incorrect referral information.

Check that the referral information is correct, and if it is, wait two days and reprocess the claim again. If the claim still cannot be processed, contact Medicare on 1800 700 199.

600

Requesting/referring provider unable to be identified

Requesting/referring provider unable to be identified. The referring GP's provider number is likely incorrect. Check it on the referral you received and edit the referral details on Halaxy so that the correct provider number is shown.

603

Newborn not yet enrolled with Medicare - no benefit payable

The patient has not yet registered with Medicare. Contact the claimant to follow up with Medicare, then reprocess the claim.

605

Referral expired - no benefit payable

The referral has expired. Check the date of the referral provided by the referring practitioner or confirm with Medicare.

606

Referring provider number not open at date of referral

The referring practitioner's Provider Number was not registered with Medicare when the referral was submitted. You should speak to the referring practitioner, who will need to advise the correct Provider Number or details.

609

Service cancelled at provider's request

The practitioner or their representative has called Medicare and cancelled the claim. The invoice should be updated, so you can reprocess the claim if you choose.

618, 619

No benefit if requested by this provider at date of request

Servicing provider number not open at date of service

The practitioner's Provider Number was not registered with Medicare or DVA for the item number at the date of service.

You need to reconfirm your Provider Number and/or check with Medicare or DVA. Once you have done that, update your details.

1005

No session matching the provided session ID currently exists

The item code does not exist. Check the item code and confirm the correct code is used.

1704

Desecure Failure

Your connection to Medicare has been temporarily disrupted. Try again.

2004

Invalid

The element name that is supplied is not valid or does not apply to the current function.

2017

The Payee provider is the same as the Serving Provider

The same provider number has been added to the invoice for both the payee and serving provider. Double check the provider number and payee provider number.

2023

Invalid

The report has not yet been made available by Medicare. Try again in another day.

2030

Failed to process claim

Medicare is unable to process the claim due to invalid data on the claim. Please ensure all claim details are correct and valid then try again. The error modal may provide more details on which details need to be amended.

2054

Date of service inconsistent

There is a disconnect between the service date, the referral date and/or the patient's date of birth. Double check all dates, including the patient's date of birth. Correct any errors and try again.

3001, 3004

Communication error; check that you have a current internet session

There is a problem with connection either from Medicare, Halaxy or your end; check your own internet connection and you are connected to the internet, wait a few minutes and try again.

7078

Medicare Item Num

Relevant for DVA claims. Specify the number of kilometres for travel claiming purposes in the invoice (edit the invoice if needed).

9006

The provider is not authorised to participate in online claiming

The Provider Number/Location ID used for the claim is not registered for online claiming in PRODA.

Check that the you have completed registration for Medicare online claiming and ensure you have requested and activated your Location ID. The Provider Number and the Location ID you want to use to claim must be registered together using the same form.

9007

The location is not authorised to undertake the function on the date of transmission

The Location ID used for the claim has not been activated. Complete all the steps in registering for online Medicare claiming.

9119-9125

The provider is identified as inactive for Online Claiming purposes

You usually receive this error when Medicare has not yet processed your Medicare online claiming registration. It usually takes 5 business days for Medicare to register practitioners, so wait until this time has elapsed before trying again (see here for more information on registering for Medicare).

If you are an allied health practitioner and the first claim you ever process is a DVA claim, you may receive error 9125 (this is a bug in DVA's claiming system that does not happen when the first claim you process is a Medicare claim). The way to overcome it is to run an Online Veteran Verification first (which allows you to check whether the DVA card details you have are correct or not), then process the claim. All future claims will be processed normally.

9201

Invalid format for data item

Something required for processing purposes has been left blank - possibly the patient's Medicare number or date of birth, the referral date or the referring GP's provider number. Check the invoice and the referral/claim details, then process the rebate again.

9202

Invalid value for data item

Some of the data submitted with the invoice does not comply with the values permitted or has failed a digit check. Check each field of the invoice and resubmit.

9204

Date in the future

A date supplied on the invoice is in the future. Double check the date and try again.

9205

Data item empty

The claim requires a Medicare officer to review it. Call Medicare on 1800 700 199 to discuss it.

9210

Date of service must be no more than 2 years in the past

The claim cannot be dated prior to two years ago. You will need to update the claim if the incorrect date is on the invoice or call Medicare for advice.

9251

ReferringProviderNum is an invalid value

The referring practitioner's provider number has been entered incorrectly. Confirm the provider number with the referring practitioner. Then update their provider number in their professional contact details in your Halaxy. This will automatically update associated invoices and referrals.

9294

DistanceKms is an invalid value

The KMs provided in the travel fee is an invalid value. Check the quantity of the travel fee and try again.

9301-9304

Patient's Medicare card number (9301), individual reference number (9302), first name (9303) or surname (9304) must be supplied

The required patient information is missing. You can add the patient's first name or surname in the Patient section of the invoice (which updates their patient profile), or the Medicare card or reference number in the Medicare claim section of the invoice (which updates the patient's Funding page).

9305, 9308

Servicing practitioner's Provider Number (9305) or Referring practitioner's Provider Number (9308) must be supplied

Your Provider Number or the referring practitioner's Provider Number is missing or incorrect. Edit your Provider Number on your Identifications page, and/or edit the referring practitioner's Provider Number by clicking the Edit icon in the Medicare claim section of the invoice, and process the claim again.

9307

An item number must be supplied for each service

A fee used on this invoice does not have an item number, or the item number is incorrect. You will need to check the item number linked to this fee. You can check the item number of a fee by navigating to your Fees List and checking the Fee Number column.

To edit the item number of a fee:

9309

Referral issue date must be supplied

The date of the referral is missing or after the date of your appointment with the patient. Edit the referral date in the Medicare claim section of the invoice (which updates the referral information on the patient's Funding page), and process the claim again.

9312

The claimant's Medicare card number or reference number has not been entered

The claimant's first name, family name, date of birth, Medicare card number and reference number must be supplied. If any one data element is supplied, then all five (5) must be supplied. Once you have added these details to the claimant's record, you can resubmit the claim.

9313, 9314, 9315

Patient/Claimant address line (9313), locality (9314) or postcode (9315) must be supplied or all claimant address elements removed

One or more of the patient's address details that you have entered on Halaxy are spelt wrongly or is incorrect. Go to the Patient section of the invoice and check and update the patient's address, particularly spelling of street name and suburb (e.g. Lake MacDonald might be incorrectly spelt as Lake McDonald). Updated information is also saved on the patient profile.

9316

The Referring/Requesting practitioner cannot be the Servicing or Principal provider

The referring practitioner is the same as the practitioner who provided the service. Confirm the referring practitioner's details and amend in the Funding page of the patient's profile or in the claim/referral section of the invoice.

9318

Non-standard referral has been set without the referral period

A standard referral means that the referral period is 12 months for GPs or 3 months for specialists. A non-standard referral has a different referral period which must be specified. You must specify the referral length in the Referral Type used for this appointment.

9323

Incomplete banking details - BSB code, account number and account name must all be supplied

The patient's bank details are incorrect or are missing some requirement elements. Confirm the bank details with the patient (or claimant), and update the patient's bank details on their Funding page.

9332

Voucher must contain at least 1 service

There needs to be at least one Medicare fee with an item code added to the invoice

9337

At least one service in the voucher must have a non zero charge amount

There needs to be a fee on the invoice with an amount greater than zero

9342

The Payee practitioner supplied is the same as the servicing provider

The payee practitioner and the practitioner on the claim are the same. If this is the case, there is no need to have the payee provider on the invoice.

9601

Claim successfully transmitted and pended for further assessment by a Customer Support Officer

The claim has been successfully transmitted but may require further assessment by a Medicare customer support officer. You may be required to lodge the claim again for further verification.

Try running a Medicare online patient verification to verify the patient's details, then try again. If you still have issues, contact the Medicare eBusiness Service Centre on 1800 700 199 for further advice about this claim.

9602

This claim cannot be lodged through Medicare Easyclaim. Please submit the claim via an alternative Medicare claiming channel.

Medicare does not provide further information. Reconfirm the referral details on the invoice and verify the patient's Medicare details. If this does not reveal further information, contact Medicare.

9604

Check bank account name

The name provided for the bank account is not a valid bank account name. The patient's first name or family name of their bank account may contain brackets or other characters (e.g. asterisks) that should be removed. Go to the patient's profile, in the Funding tab and check the Bank Account section to confirm the correct name.

9605

Another Medicare Card may have been issued to the patient or the details you entered do not match those held by Medicare.

The Medicare details that are trying to be submitted with this claim are not the Medicare information that Medicare have on file for this patient. You will need to contact the patient to obtain the correct Medicare details, update their profile and then resubmit the claim.

9606

Another Medicare Card may have been issued to the claimant or the details you entered do not match those held by Medicare.

The Medicare card that has been used with the claim does not match the Medicare Card details that Medicare have on file for this claimant. It may be that a new Medicare card was issued since the previous card was added to the patient's file or that these details are incorrect.

Try to verify the claimant's Medicare details. You may need to contact the claimant to clarify the Medicare details that you have on file for them. Once these details have been updated in the Funding page of the patient's profile, you will be able to reprocess the claim.

9611

Check Item

The item number or the item itself that has been entered for this service is incorrect or invalid at the date of service. Check the data on the invoice so that it is correct.

9614

Check bank account number

The bank account number provided is not a valid bank account. Confirm the bank account details in the patient's profile (Funding tab).

9616

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

The patient's bank details are either incorrect (the BSB does not have the correct number of digits) or are not able to be used for this payment. Confirm the bank account details in the patient's profile (Funding tab).

9618

Check amount in the Charge Field

Either an amount has not been entered in the charge field or an invalid amount has been entered.

9624

A subsequent consultation has been keyed and the date of service is after the referral expiry date

Check the date of the referral provided by the referring practitioner or confirm with Medicare.

9625

Claimant address needs to be updated with Medicare, Issue account/receipt for the claimant to submit via an alternative Medicare claiming channel

There is an issue with the claimant's physical address that Medicare has on file. The claimant will need to get in contact with Medicare to update their physical address. You can attempt to resubmit the claim after the claimant has updated their address, but the claimant may need to submit the claim online or at a Medicare office. If you are unable to resubmit the claim via Halaxy, provide the patient with a copy of the invoice to submit the claim on their own.

9628

Referral or request required

There was no referral when the invoice was submitted. Open the invoice and check if a referral has been entered. If not, add the referral and resubmit the claim.

9630

Please check the request or referral details

The referral is either incorrect or has run out, due either to the number of appointments or the referral date having expired. Check the referral information on the patient's Funding page and make sure the referral date and the referring practitioner's provider number are correct.

9632

Duplicate of service already paid.

You may be claiming for the same service on the same day with the same practitioner.

If there was more than one service performed for the patient on the same day with the same item number and the same practitioner, you'll need to include additional information with the claim when you push it through to Medicare to investigate:

The claim may not be successful, but it will be sent to Medicare for investigation.

9634

A new Medicare card has been issued. Please update your records and ask the claimant to use the new card number for any future claims.

The claimant Medicare details that are on the patient's profile are expired. You will need to update the patient's profile (Funding tab) with the new Medicare details. Once this is done, you can resubmit the claim.

9638, 9312

Claimant details required - patient or quoted claimant is a minor, or claimant details are missing (9312)

The rebate cannot be provided to the patient because the patient is under the age of 18. Add a claimant (e.g. a parent) or edit details of a claimant to whom the rebate is paid by adding their Medicare and deposit account details on the Medicare Claim section of the invoice.

9641

A restrictive condition exists

This is often linked to the referral eligibility. Double check and confirm the referral details that have been added to the claim. If all details are correct, contact Medicare for further information.

9655

A LSPN is required

This claim requires a Location Specific Practice Number. A LSPN is required at all locations that provide diagnostic imaging services. When you submit a claim with diagnostic imaging services, you will need to include a LSPN by clicking Additional Information in the pop-up after clicking Process Rebate from the invoice.

9698

Service is possible aftercare

The service is possibly aftercare. If the service is normal aftercare, you cannot submit the rebate. If the service is not normal aftercare, after clicking Process Rebate or Process Bulk Bill from the invoice, click Additional Information in the pop-up and set the "Aftercare Override" field to "Yes - not normal aftercare", then resubmit the claim.