Troubleshooting Medicare Errors
When submitting Medicare claims you may run into errors that prevent the claim from being sent which are usually easily fixed if you know what to look for. We have put together a list of common errors below and explain how you might be able to fix each of them.
Once you have corrected the error you will need to resubmit the claim. You can do this in the same way that you submitted the claim originally.
Please note that you cannot delete rejected Medicare claims. These will remain in the account.
In this article:
2017 : The Payee Provider specified is the same as the Servicing Provider
When the servicing provider is also the one receiving payment the payee provider fields need to be blank or Medicare will generate this error. To resolve this go to Setup → Calendar, Click the provider's name → Insurers (on the left). Edit the relevant Medicare insurer and remove the payee information. You can then resubmit the claim.
2038 : The referral/request type is inconsistent with the service type set for this claim.
You can fix this by following the steps outlined in the error message: go to Setup → Calendar, Click the provider's name → Insurers (on the left). From here, edit their Medicare insurer and change the Service Type. You will simply need to swap this with the other option (for example, if it is set to General change it to Specialist).
The options marked with (DVA) are not valid for use when submitting Medicare claims and can only be used for DVA claiming.
9201 : Invalid format for data item
This error simply indicates that some of the information provided is either incorrectly formatted or is missing. This is most commonly generated when the referring provider number is missing. To check this, simply scroll down and look over the data submitted and ensure that all required fields are filled and accurate.
9202 : Invalid Value For Data Item
There are few reasons why this error can occur:
- The patient has a PO Box as the address set up in the file
- The account holder of the patient has a PO Box attached to their file. A physical address is required, as a PO Box is not accepted by Medicare. This will need to be changed to a physical address
- If there is no date of birth entered or an invalid date of birth
9325 : Service Type not Supplied
This just means that a Service Type hasn't been selected for the provider. To fix this, you will need to go to Setup → Calendars → Click the provider's name → Insurers and then select Medicare. From the Service Type drop-down, you will need to select Specialist (Medicare) and then Save.
9501/9602 : This claim cannot be lodged through Medicare Easyclaim. Please submit the claim via an alternate claiming channel.
This error is commonly generated when there is no referral listed or connected to the invoice being claimed. It can also indicate that the client has met the maximum number of sessions possible under their referral (for example, all of the sessions within the mental health care plan)
9641 (or 9601) : Your claim was not able to be processed automatically due to a non-critical warning. You may try resubmitting the claim for manual processing.
This is a non-critical warning and as such can usually be ignored. To submit the claim and force it through simply click the green Resubmit Claim button or create a new claim and tick Accept Non Fatal Warnings toward the bottom right of the page prior to clicking Send. Once the claim has been submitted it will go through with a status of Referred.
9603 : Check the client's address. The address not entered is invalid.
When this error is appearing but the address appears to be correct (and the client has confirmed that the address matches what Medicare have on record) you may simply need to check that the spelling and format are correct. The easiest way to do this is to put the address into Google Maps and copy what they provide.
9630 : Please check the request or referral details.
This may mean that the referral details are incorrect, the referral has exceeded the number of appointments, or the referral date has expired. Because the Claim was immediately rejected, Medicare may have no record of this Claim. At that point, system checks may have found that the referral has exceeded the number of appointments which is why it stopped it from being submitted. It will require checking if the Provider Number of the Referring GP is correct, and/or checking with either the Referring GP or Medicare whether they've exceeded their number of appointments.
Invalid medicare provider number: Alpha character does not match
This error is generated whenever the provider number that's entered doesn't exactly match what Medicare has on record. If the provider number is correct and this error is still being generated you can resolve it by placing a zero (0) at the start of the provider number and trying again.
If you run into an error that isn't listed here, or the suggested solutions haven't worked for you please let us know so that we can assist you with the claim. In your email, please provide us with the invoice number relating to the claim so that we can investigate what might be causing the issue.