Medicare Claim Status

When you submit a Patient Claim or Bulk Bill Medicare will supply you with a status response which will include the claim status. If the claim is not successful you should see an error code which will give instructions on how to resolve the issue before re-submitting the claim.

If you are processing a Patient Claim:

Assessed: The claim has been accepted and has responded as successful. The payment should be made straight away.

Referred: There was a non critical warning. If you have ticked 'Accept Non-Fatal Warnings' this will force the claim to be processed and it will be referred to a Medicare Representative for examining.

Warned: There were non critical warnings and the claim was not accepted, you will be provided with an error code which will give you information on what will need to be fixed so that you can submit the claim again, or you can submit the claim by ticking 'Accept Non-Fatal Warnings'.

Rejected: There was a critical error and the claim can't be accepted.

Prepared: The claim has been stored for later transmission. 

 

If you are processing a Bulk Bill:

All Bulk Bills will have a 'Referred' status. The Bulk Bills are sent to Medicare who review each claim and then either accept or reject the claim.

 

There are two reports which you can run to check on the progress of the Bulk Bill: the Processing Report and the Payment Report. To run these reports you will need to go into the editing claim page (Tools> Medicare> Click on the Claim ID, or go into the clients invoices page and edit the invoice and click on the Medicare link). When in the editing claim page you can then have the option to run a Processing Report or a Payment Report.

 

Processing Report: The Processing Report provides a summary of information including the Charge Amount and the Claim Benefit Paid. If there has been no Claim Benefit Paid there will be an Explanation Code and Text with information on why the claim was not paid. 

 

Payment Report: The Payment Report will summarise all Bulk Bill payments that have been paid for the same date. This will show you the Total Deposit Amount, Date of Payment and the Bank Details which the payment was deposited into. It will also list all of the claims which were paid on that day.

 

If your claim is not successful Medicare will provide you with an error code which will give you some information on how to resolve the issue by following the instructions provided for each error code. If you are unable to resolve the issue by following the instructions given by the error code you will need to contact the Medicare eBusiness Service Centre on 1800 700 199.

Here are some common Error Codes and steps to resolve them:

Medicare 4 Digit Return Codes.csv (60 KB)