Medicare Claim Statuses

When a claim is submitted to Medicare a status will be returned to indicate how the claim went and inform you whether or not it was succesfully submitted or if something needs to be changed. In this article we'll go over what each of the possible statuses is for patient claims and bulk bills and outline what you need to do for each (if anything).

In this article:

Patient Claims

When you submit a Patient Claim 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.

The status' are as follows: 

  • Assessed: The claim has been accepted and has responded as successful. Medicare will pay the rebate the to client. 
  • 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. 

Bulk Bills

All successful 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. When you submit a bulk bill to Medicare they will not return an immediate payment response. 

  • Referred Status: If the claim has been successfully sent to Medicare the status of the claim will be Referred. This indicates that Medicare are reviewing the claim and they will respond with a payment response in 24+ hours. This is returned in the form of a Payment and Processing report (see more details on these reports below).
  • Rejected Status: If the claim is not successfully sent to Medicare you will see that it has been Rejected. Medicare will return an error code indicating why it was rejected and you will need to resolve this prior to resubmitting the claim. This is commonly due to missing claim information etc. 

How to check if your Bulk Bill has been paid: 

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.

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