Sometimes it's unclear why a claim is rejected. Search the table on this page to find the rejection message, learn what it means and understand the next steps.
Are you a Medibank member?
If you're looking to understand why your claim was rejected, please visit our Help & Support page for members.
| Rejection Code on Remittance | Rejection Description | Next steps |
|---|---|---|
| 1162 | A CLAIM FOR THIS SERVICE HAS BEEN PREVIOUSLY PROCESSED | Please check if the claim was previously submitted and paid, e.g. via simplified billing, bulk billing or patient claiming channels. If there was more than one procedure on the same day, please resubmit with more information e.g. times, sites. |
| 1461 | ADJUSTMENT TO BENEFIT PREVIOUSLY PAID | The claim has been adjusted and paid. Please await remittance or EFT top-up. |
| 1410 | AGE RESTRICTION APPLIES FOR THIS ITEM - VERIFY DETAILS | Please check MBS online to review any age restriction for this item and compare it with patient's age/DOB. Then resubmit with correct item number for patient's age. |
| 1553 | APPROVED COLLECTION CENTRE NUMBER NOT SUPPLIED | This rejection code relates to missing collection centre number. Please resubmit claim with collection centre number (SCP number). |
| 1557 | ASSOCIATED RVG ANAESTHETIC SERVICE NOT CLAIMED | Please review the anaesthetic RVG and resubmit as per the RVG billing guidelines which can be found on Services Australia's website (www.servicesaustralia.gov.au). |
| 1550 | ASSOCIATED SERVICE NOT CLAIMED - NO BENEFIT PAYABLE | Please check the MBS online item description. This item must be paired with an associated item, which is missing. Please resubmit the claim after reviewing Medicare requirements for this item. |
| 1108 | BENEFIT IS NOT PAYABLE FOR THE SERVICE CLAIMED | This rejection code indicates the item number is not payable. Please review the item number and check MBS item description for any requirements and restrictions. |
| 1179 | BENEFIT NOT PAYABLE - ASSOCIATED SERVICE ALREADY PAID | An associated service has been paid. Please check payment records and MBS for item description. Medicare has already paid for a claim associated with this item. |
| 1413 | BENEFIT NOT PAYABLE - DATE OF SERV PRIOR TO DATE OF REQUEST | The date of service is before the date of referral. Please review referral date and resubmit with valid dates. |
| 1412 | BENEFIT NOT PAYABLE - PROVIDER UNABLE TO CLAIM THIS SERVICE | This provider number cannot claim this item number. Please contact Medicare provider registration to clarify. |
| 1402 | BENEFIT NOT PAYABLE- NUMBER OF PATIENTS ATTENDED REQUIRED | The number of patients seen/attended is required as this item has a derived fee and is calculated based on number of patients. Please resubmit and notate number of patients. |
| 1562 | BENEFIT PAID ON ASSOCIATED RVG ANAESTHETIC ITEM | An associated RVG has already been paid. If you are a second anaesthetist, assistant anaesthetist or perfusionist, please resubmit with times or clinical notes. |
| 1436 | CANNOT CLAIM OUT OF HOSPITAL SERVICE THROUGH SIMPLIFIED BILL | This rejection code relates to the item number being an out of hospital item and therefore cannot be billed via simplified billing, which is for inpatient only. Please check MBS online and either bulk bill or send as patient claim. |
| 1430 | CONFLICTING REFERRAL DETAILS - PLEASE CLARIFY | This rejection code relates to conflicting referral details. Please resubmit with correct referring provider number and referral date. |
| 1506 | CONSULTATION NOT PAYABLE ON SAME DAY AS SURGICAL PROCEDURE | This rejection code indicates either a surgical or consult item has been paid. Consults are not payable same day as surgery with MBS fees valued at $300 or more. |
| 1282 | DATE OF SERVICE OUTSIDE OF REFERRAL/REQUEST PERIOD | The date of service is outside of referral period. Please check if the referral date entered is correct and if the referral has expired. Please resubmit claim with valid a referral date. |
| 1137 | DETAILS OF REQUESTING PROVIDER NOT SHOWN ON ACCOUNT/RECEIPT | The referral details are missing. Please resubmit with valid referring provider number and referral date. |
| 1154 | DIAGNOSTIC IMAGING MULTIPLE SERVICE RULE APPLIED TO SERVICE | Medicare diagnostic imaging service rule has been applied reducing payable benefits. |
| 1515 | EQUIPMENT GREATER THAN 10 YEARS OLD | This rejection code is due to equipment being over 10 years old. Please check equipment registration with Medicare or resubmit with a different LSPN/equipment. |
| 1350 | HOSPITAL REFERRAL - PAID AT SPECIALIST/CONSULTANT RATE | Medicare has paid at specialist/consult rate as it was an in-hospital referral. |
| 1629 | INITIAL PDT THERAPY ITEM NOT PRESENT ON PATIENT HISTORY | This rejection code is due to initial PDT therapy item not being present on patient history. Please review initial PDT therapy item. |
| 1159 | ITEM ASSOCIATED WITH OTHER SERVICE ON WHICH BENEFIT PAYABLE | This rejection code indicates a Medicare item number restriction. Please check MBS online for item number descriptions. If there are different sites involved, please resubmit mentioning sites. |
| 1160 | MAXIMUM NUMBER OF SERVICES FOR THIS ITEM ALREADY PAID | Please check MBS online for how many times this item can be paid within a certain period. The maximum number is applied across all channels e.g. simplified billing, bulk billing or patient claiming channels. |
| 1565 | MULTIPLE DI AND VASCULAR ULTRASOUND SERVICE RULES APPLIED | Medicare has applied the multiple diagnostic imaging and vascular ultrasound service rule. |
| 1441 | MULTIPLE ECHOCARDIOGRAM AND DI SERVICES RULES APPLIED | Medicare has applied the multiple echocardiogram and diagnostic imaging services rule. |
| 1440 | MULTIPLE ECHOCARDIOGRAM SERVICES RULE APPLIED | Medicare has applied the multiple echocardiogram service rule. |
| 1512 | MULTIPLE MUSCULOSKELETAL MRI SERVICE RULE APPLIED | Medicare has applied the multiple musculoskeletal MRI service rule. |
| 1615 | MULTIPLE PROCEDURES - NOTATE TIMES AND AREA OF TREATMENT | Please check if the same item or any associated item has been claimed. If there are multiple sites or times involved, please notate, and resubmit. |
| 1564 | MULTIPLE VASCULAR ULTRASOUND SERVICES SITE RULE APPLIED | Medicare has applied the multiple vascular ultrasound services site rule. |
| 1614 | NO BENEFIT PAYABLE - PLEASE NOTATE TIME OF EACH VISIT | Medicare requires times for each visit. If provider is claiming item more than once, please notate times for each visit and resubmit. |
| 1141 | NO BENEFIT PAYABLE FOR SERVICES PERFORMED BY THIS PROVIDER | This provider number cannot claim this item number. Please contact Medicare provider registration to clarify. |
| 1360 | NO BENEFIT PAYABLE WHEN REQUESTED BY THIS PROVIDER | The referring provider number cannot refer for this item number. For example, certain items numbers can only be referred by specialists. Please check MBS online then resubmit with a different referring provider number or referring provider may have to clarify with Medicare provider registration. |
| 1432 | NOT MULTI-OP - MORE INFORMATION REQUIRED TO PAY BENEFIT | This rejection code usually indicates that a surgical item has already been paid. To add or amend surgical items, please contact health fund to organise a Medicare adjustment. |
| 1525 | ONLY ATTRACTS BENEFIT WHEN CLAIMED VIA BULK BILLING | This rejection code indicates item number can only be paid when bulk billed. Please do not submit via simplified billing channel and bulk bill instead. |
| 1353 | PATHOLOGY ITEMS NOT PRESENT - NO BENEFIT PAYABLE | This rejection code indicates pathology items are missing. Please check MBS online for associated pathology items and ensure they are being claimed. |
| 1211 | PATIENT NOT COVERED BY THIS CARDNUMBER AT DATE OF SERVICE | This rejection code indicates patient is not covered by this Medicare card number for date of service. Please check card number start and end date with patient. |
| 1414 | PROVIDER PRACTICE LOCATION IS CLOSED AT DATE OF SERVICE | This provider number/provider practice location is closed for this date of service. Please ensure date of service is correct or check provider number open/close date with Medicare provider registrations. |
| 1611 | REFERRAL/REQUEST DETAILS NOT SUPPLIED - NO BENEFIT PAYABLE | The referral details are missing. Please resubmit with valid referring provider number and referral date. |
| 1606 | REFERRING PROVIDER NUMBER NOT OPEN AT DATE OF REFERRAL | The referring provider number is inactive at date of referral. Please resubmit with a different referring provider number or referring provider should contact Medicare provider registration to clarify. |
| 1500 | REJECTED IN ASSOCIATION WITH ANOTHER ITEM IN THIS CLAIM | This rejection code indicates a Medicare item number restriction between these item numbers. Please check MBS online for item number descriptions. If there are different sites involved, please resubmit mentioning sites. |
| 1514 | REQUIRED EQUIPMENT TYPE CODE NOT ON LSPN REGISTER | The equipment is not on the Medicare LSPN registry. Please check LSPN number or contact Medicare to clarify LSPN. |
| 1558 | RVG ANAESTHETIC ITEM NOT CLAIMED | Please review the anaesthetic RVG and resubmit as per the RVG billing guidelines which can be found on the Services Australia website (www.servicesaustralia.gov.au). |
| 1560 | RVG ITEM RESTRICTION | There is a Medicare restriction between RVG items, please check RVG and resubmit. If claim is partially paid, please contact health fund to organise a Medicare adjustment |
| 1556 | RVG TIME ITEM NOT CLAIMED | Please review the anaesthetic RVG and resubmit as per the RVG billing guidelines which can be found on Service Australia (www.servicesaustralia.gov.au). |
| 1267 | SERVICE NOT PAYABLE - ASSOCIATED SERVICE NOT PRESENT | Please check MBS online item description. This item must be paired with an associated item which is missing. Please resubmit claim after you review Medicare requirements for this item. |
| 1252 | SERVICE POSSIBLY AFTERCARE | Medicare has rejected as the item is possibly aftercare. If this item is not part of aftercare, please resubmit with "not normal aftercare." |
| 1416 | SERVICES FORM A COMPOSITE ITEM - COMPOSITE ITEM REQUIRED | This rejection code indicates a composite item is required, please check MBS online for item number requirements and resubmit with composite item. |
| 1619 | SERVICING PROVIDER NUMBER NOT OPEN AT DATE OF SERVICE | The service provider number is not open at date of service. Please ensure date of service is correct or provider should contact Medicare provider registration to clarify. |
| 1507 | SITE NOT ACCREDITED FOR THIS SERVICE | Please check if site and its LSPN is accredited for this service. Site may have to contact Medicare to clarify. |
| 1551 | SPECIMEN COLLECTION POINT IS INCORRECT OR NOT SUPPLIED | The specimen collection point is missing or invalid. Please resubmit with valid specimen collection point. |
| 1163 | SURGICAL/ANAESTHETIC ITEM/S ALREADY PAID FOR THIS DATE | This rejection code indicates surgical/anaesthetic items already paid for this date. If there was more than one operation, please resubmit with times for both operations e.g. "Op 1 @ 0900hrs, Op 2 @1500hrs.” |
| 1406 | UNABLE TO ASSESS CLAIM - PLEASE FORWARD DOCUMENTS | The rejection code indicates Medicare requires more information/manual documents. Please send claim to health fund manually with operation report to forward to Medicare. |
| 1120 | AGE RESTRICTION APPLIES TO THIS ITEM | Please check MBS online to review age restriction for this item and compare it with patient's age/DOB. Then resubmit with correct item number for patient's age. |
| 1243 | APPORTIONED CHARGE AND TOTAL BENEFIT FOR MULTIPLE PROCEDURE | This code indicates Medicare has combined and allocated a total MBS fee for claim. |
| 1151 | ASSOCIATED SERVICE ALREADY PAID-ADJUSTMENT BEING PROCESSED | This code indicates associated item number has been paid and there is an adjustment in process. Please check records for adjustment status or contact health fund for update. |
| 1316 | BENEFIT NOT PAYABLE - ITEM CANNOT BE SELF-DETERMINED | This rejection code indicates item number cannot be self-deemed. A valid referral is required, please resubmit with referring provider number and referral date. |
| 1171 | BENEFIT NOT PAYABLE - PROVIDER MAY ONLY ACT IN ONE CAPACITY | This rejection code indicates provider can only act in one capacity (i.e. primary surgeon or assist surgeon) in one operation/one anaesthetic. If there was more than one operation (i.e. more than one anaesthetic claimed), please resubmit with times for both operations. |
| 1138 | BENEFIT ONLY PAYABLE WHEN SELF-DETERMINED/DEEMED NECESSARY | This rejection code indicates item number can only be paid when self-deemed. Please resubmit as self-deemed. |
| 1158 | BENEFIT PAID ON ASSOCIATED ABANDONED SURGERY/ANAE ITEM | This code indicates benefits have been paid on associated abandoned surgical item or anaesthetic item. |
| 1370 | BENEFIT PAID ON ITEM NUMBER OTHER THAN THAT CLAIMED | This rejection code indicates benefits have already been paid against another item number. Please check payment records. |
| 1107 | BENEFIT PAID ON ITEM NUMBER OTHER THAN THAT CLAIMED | This rejection code indicates benefits have already been paid against another item number. Please check payment records. |
| 1567 | BENEFIT PAID ON MAIN DIAGNOSTIC IMAGING ITEM | This code indicates benefits have already been paid on main diagnostic imaging item. Please check claim/payment records. |
| 1561 | BENEFIT PAID ON RVG ITEM CLAIMED | This code indicates benefits have been paid on RVG item. |
| 1208 | CARDNUMBER USED HAS EXPIRED | The Medicare card has expired. Please check card details with patient and resubmit with correct Medicare card number. |
| 1504 | CHARGE AMOUNT MISSING/INVALID - NO BENEFIT PAYABLE | There is an issue with charges being too low. Please ensure all charges are above 100% MBS rates. If multiple surgical items are billed, please ensure the multi-op rule has been applied correctly, item with highest MBS fee is 100%, second highest 50% and the rest at 25%. Please note if there is an amputation item, it must be 100% MBS fee and multi-op rule does not apply. |
| 1438 | CONSULTATION AND DI ITEM/S NOT PAYABLE ON SAME DAY | Consultation and diagnostic imaging items are not payable on the same day. |
| 1612 | DATE OF REFERRAL AFTER DATE OF SERVICE - NO BENEFIT PAYABLE | Date of referral is after date of service. Please review referral date and resubmit with valid dates. |
| 1212 | DATE OF SERVICE USED IS IN THE FUTURE | Date of service submitted is in the future. Please review date of service and resubmit with valid date. |
| 1206 | ITEM NUMBER DOES NOT ATTRACT A BENEFIT AT DATE OF SERVICE | This rejection code indicates item number is closed at date of service. Please check when this item was closed by Medicare and resubmit with an active or the replacement item number. |
| 1103 | LETTER OF EXPLANATION IS BEING SENT SEPARATELY | Medicare has rejected the claim and will send letter of explanation separately. |
| 1536 | LOCATION SPECIFIC PRACTICE NUMBER NOT SUPPLIED | The LSPN is missing. A valid LSPN is required for imaging items, please resubmit with LSPN. |
| 1539 | LOCATION SPECIFIC PRACTICE NUMBER NOT VALID AT DATE OF SERV | The LSPN is invalid for date of service. Please resubmit with valid LSPN or contact Medicare to clarify open or closure date for LSPN. |
| 1150 | MEMBER HAS NOT SUPPLIED DETAILS TO PERMIT CLAIM PAYMENT | This code indicates patient has not supplied details for claim payment. Please ask patient to contact Medicare. |
| 1101 | MORE DETAILS OF SERVICE REQUIRED TO ASSESS BENEFIT | Medicare requires more details e.g. times, sites, clinical details. Please resubmit with more information. |
| 1458 | NO ACTION REQUIRED - BENEFIT PAID ON ADJUSTED CLAIM | Claim has been adjustment by Medicare and benefits paid/topped up. A remittance will follow. |
| 1457 | NO ACTION REQUIRED - LINE ADJUSTED TO PROCESS CLAIM | Please ignore, no action required. Line adjusted to process claim. |
| 1102 | NO AMOUNT CHARGED IS SHOWN ON ACCOUNT/RECEIPT | This code is due to missing or invalid charge on invoice. Please review charge and resubmit. |
| 1333 | PROVIDER MUST CLAIM TIME-BASED ITEMS | Provider must claim time-based items. Please check MBS online and resubmit with time-based items. |
| 1633 | REFER BACK TO THE SPECIALIST (REFERRING PROVIDER IS CLOSED) | Referring provider number is closed, please check with specialist/referring doctor and resubmit |
| 1136 | REFERRAL DETAILS NOT SUPPLIED - PAID AT G.P. RATE | This code is due to missing referral details, paid at GP rate. |
| 1605 | REFERRAL EXPIRED - NO BENEFIT PAYABLE | The referral has expired. Please check if referral date entered is correct and the referral validity period. Please resubmit claim with valid referral. |
| 1454 | RESUBMIT CLAIM FOR SERVICE - SOME DETAILS NOT SHOWN ON IMAGE | This rejection code is due to missing details on invoice e.g. provider number, date of service, LSPN etc. Please resubmit with all relevant details. |
| 1453 | RESUBMIT CLAIM FOR SERVICE-CLAIM DETAILS DO NOT MATCH IMAGE | This rejection code is due to a mismatch between claim/patient details and document. Please resubmit with correct documents/invoice. |
| 1452 | RESUBMIT CLAIM FOR THIS SERVICE - IMAGE NOT CLAIM RELATED | This rejection code is due to document submitted unrelated to claim. Please resubmit with correct documents/invoice. |
| 1455 | RESUBMIT CLAIM FOR THIS SERVICE-INCLUDE ACCOUNT AND RECEIPT | This rejection code is due to missing invoice. Please resubmit with invoice. |
| 1232 | SERVICE CLAIMED NOT COVERED BY MEDICARE | This rejection code indicates the service or item is not covered by Medicare. Please send account to patient directly. |
| 1242 | SERVICE IS PART OF A MULTIPLE PROCEDURE | This rejection code usually indicates that a surgical item has already been paid, to add or amend surgical items, please contact health fund to organise a Medicare adjustment. |
| 1106 | SERVICING PROVIDER UNABLE TO BE IDENTIFIED | The service provider number cannot be identified. Please resubmit with valid service provider or contact Medicare provider registrations to clarify. |
| 1113 | TOTAL CHARGE SHOWN ON ACCOUNT APPORTIONED OVER ALL ITEMS | This code indicates charges have been spread across all items. |
| 1164 | ASSISTANT SURGEON BENEFIT NOT PAYABLE | The assistant surgeon benefit is not payable. Please check MBS description for surgical item numbers. If there is no mention of “(assist),” the item number does not attract an assist benefit. |
| 1563 | ASSOCIATED RVG SERVICE ALREADY PAID | An associated RVG has already been paid. If this is a second anaesthetic, assistant anaesthetist or perfusionist, please resubmit with times or notes. |
| 1261 | ASSOCIATED SURGICAL ITEMS/ANAESTHETIC TIME NOT SUPPLIED | The associated surgical item or anaesthetic time is missing, please resubmit with associated surgical item or anaesthetic time. |
| 1260 | BENEFIT ASSESSED WITH ASSOCIATED ITEM ON STATEMENT | This item has been assessed with an associated item in this claim. |
| 1401 | BENEFIT NOT PAYABLE - CHARGE AMOUNT MISSING OR INVALID | The charge is missing or too low. Please ensure all charges are above 100% MBS rates. If multiple surgical items are billed, please ensure the multi-op rule has been applied correctly, item with highest MBS fee is 100%, second highest 50% and the rest at 25%. Please note if there is an amputation item, it must be 100% MBS fee always, multi-op rule does not apply. |
| 1404 | BENEFIT NOT PAYABLE - REFERRAL/REQUEST DETAILS REQUIRED | The referral details are missing. Please resubmit with valid referring provider number and referral date |
| 1256 | BENEFIT NOT PAYABLE ON THIS SERVICE FOR A HOSPITAL PATIENT | This rejection code indicates benefit is not payable for a hospital patient. Please check MBS online as this may be an outpatient item which has to be bulked bill or submitted as patient claim. |
| 1184 | BENEFIT PAID FOR ADDITIONAL TIME ITEM USING A DERIVED FEE | This code indicates Medicare has paid benefits for additional time item using a derived fee. |
| 1555 | BENEFIT PAID ON MAIN RVG ANAESTHETIC ITEM | This code indicates benefits have been paid on main RVG anaesthetic item. |
| 1280 | CANNOT IDENTIFY SERVICE. RESUBMIT WITH CORRECT MBS ITEM | Service cannot be identified, suggesting the MBS item is invalid. Please ensure a valid MBS item is used and resubmit |
| 1227 | DATE OF SERVICE PRIOR TO DATE ELIGIBLE FOR MEDICARE BENEFIT | This rejection code indicates date of service is before patient is eligible for Medicare benefits. Patient will have to contact Medicare to clarify date in which they can start claiming Medicare benefits. |
| 1308 | IVF SERVICE - CONDITIONS NOT MET - NO BENEFIT PAYABLE | This rejection code is due to IVF conditions not met so no benefits payable. Please check MBS to check exact IVF conditions. |
| 1325 | LABORATORY NOT ACCREDITED FOR BENEFITS FOR THIS SERVICE | This rejection code is due to laboratory not being accredited for this service. Please contact Medicare to clarify pathology laboratory accreditation. |
| 1538 | LOCATION SPECIFIC PRACTICE NUMBER NOT RECOGNISED | The LSPN is not recognised/invalid. Please resubmit with valid LSPN or contact Medicare to clarify LSPN details. |
| 1505 | MORE INFORMATION REQUIRED. EVIDENCE OF CONDITION | The rejection code indicates Medicare requires more information - evidence of condition. Please send claim to health fund manually with evidence of condition, which will then be forwarded to Medicare. |
| 1513 | MULTIPLE MUSCULOSKELETAL MRI AND DI SERVICES RULES APPLIED | This code indicates multiple musculoskeletal MRI and DI services rule has been applied. |
| 1168 | NOT PAYABLE WITHOUT ASSOCIATED OPERATION/ANAESTHETIC ITEM | The claim is not payable without associated surgical or anaesthetic claim, please ensure associated surgical or anaesthetic item is claimed. |
| 1125 | NOT PAYABLE WITHOUT ASSOCIATED OPERATION/ANAESTHETIC ITEM | The claim is not payable without associated surgical or anaesthetic claim, please ensure associated surgical or anaesthetic item is claimed. |
| 1169 | OPERATION/ANAESTHETIC ITEM NOT CLAIMED | The operation or anaesthetic item has not been claimed, please ensure operation or anaesthetic item is claimed. |
| 1378 | PROVIDER CANNOT REFER/REQUEST SERVICE AT DATE OF REQUEST | The referring provider number cannot refer for this service/item at date of referral. Please ensure date of referral is request or referring provider may have contact Medicare provider registration to clarify. |
| 1338 | PROVIDER NOT REGISTERED TO CLAIM BENEFIT AT DATE OF SERVICE | The rejection code indicates service provider is not registered to claim Medicare benefits at date of service. Please ensure date of service is correct or contact Medicare provider registration to clarify. |
| 1732 | REFERRAL PERIOD NOT VALID FOR REFERRING PROVIDER | The rejection code indicates referral period is invalid for referring provider, please ensure the referring period is valid e.g. GPs have 12 months, specialists 3 months etc. |
| 1129 | SERVICE IS NOT PAYABLE WITHOUT THE BASE ITEM/S | Please check MBS online as there is a base item to pair with. Please resubmit with base item. |
| 1554 | TOTAL BENEFIT FOR ANAESTHETIC SERVICE | This code indicates the total benefit for anaesthetic has been allocated and paid. |
| 1421 | WRONG ASSISTANT ITEM USED FOR THE OPERATION/S PERFORMED | This rejection code indicates wrong assistant item used. Please note 51300 is for total MBS surgical fee below a certain threshold, 51303 is for total MBS surgical fee above that threshold. Please check MBS online for current threshold and what primary surgeon has billed. Please resubmit with correct assist item. |
| 1475 | PATIENT/SERVICE DETAILS INVALID OR MISSING | This rejection code indicates patient/service details are missing. Please resubmit with patient full name, DOB, Medicare card number, hospital provider number etc. |
| 1126 | SERVICE IS NOT PAYABLE WITHOUT RADIOLOGY SERVICE | The rejection code indicates service is not payable without radiology service. Please check MBS for item number requirements and ensure radiology item is claimed. |
| 1552 | SPECIMEN COLLECTION POINT NOT VALID AT DATE OF SERVICE | The specimen collection point is invalid at date of service. Please resubmit with valid specimen collection point or contact Medicare to clarify specimen collection point details. |
| 1444 | Required eligible base item not present in the same claim | Please check MBS online, a base item must be billed together with this item. Please add required base item to claim and resubmit. |
| 1445 | Benefit paid on associated base item | Benefit paid on associated base item. |
| 1446 | Total benefit for plastic and reconstructive procedure paid | Total benefit for plastic and reconstructive procedure paid. |
| 1170 | ASSISTANT ANAESTHETIC BENEFIT NOT PAYABLE | This rejection code indicates assistant anaesthetist benefits are not payable. |
| 1128 | BENEFIT PAID ON ASSOCIATED FRACTURE/AMPUTATION ITEM | This code indicates benefits have been paid on associated fracture or amputation item. |
| 1428 | DATE OF SERVICE OVER 2 YEARS - LATE LODGEMENT FORM REQUIRED | This rejection code is due to date of service being over 2 years. Please fill out a Medicare late lodgement form, then contact health fund for forwarding to Medicare. |
| 5 | DATE OF SERVICE PRIOR TO MEMBERSHIP EFFECTIVE DATE | This rejection code is due to date of service being prior to membership start date, please ask patient to contact health fund to clarify start date. |
| 9777 | DUPLICATE TRANSACTION ID | Duplicate transaction ID. Please check if this is a duplicate claim. |
| INVALID VALUE FOR DATA ITEM. THE DATA ELEMENT DOES NOT COMPLY WITH THE VALUES PERMITTED OR HAS FAILED A CHECK DIGIT CHECK. | This rejection code is due to missing details e.g. missing Medicare IRN, referral details, LSPN. Causing Medicare's online system to auto-reject. Please resubmit with all details. This may also be related to a deceased member. If this is the case, please contact health fund for manual sending to Medicare. | |
| Please note for pathology, post claim to health fund before making contact. | ||
| 1374 | OLD CARD ISSUE USED - BENEFIT NOT PAYABLE - ALSO REFER | The old Medicare card was used, please resubmit with updated card number. |
| THE DATA ELEMENT BEING SET IS INCONSISTENT WITH OTHER DATA ELEMENTS ALREADY SET OR A DATA ELEMENT HAS BEEN SET AND A RELATED CONDITIONALLY REQUIRED DATA ELEMENT HAS NOT BEEN SET. | This rejection code is due to missing details e.g. missing Medicare IRN, referral details, LSPN. Causing Medicare's online system to auto-reject. Please resubmit with all details. This can also be related to a deceased member. If this is the case, please contact health fund for manual sending to Medicare. | |
| Please note: for pathology, post claim to health fund before making contact. | ||
| 8009 | THE NAME SUPPLIED FOR THIS INDIVIDUAL DIFFERS FROM THAT HELD BY MEDICARE. THIS INDIVIDUAL ONLY HAS ONE NAME. PLEASE CHECK THE NAME AND UPDATE YOUR RECORDS. | This rejection code is due to name discrepancy with Medicare. Patient only has one name. Please contact fund for manual sending to Medicare. |
| 9650 | THE PATIENT DATA SUPPLIED FAILED VALIDATION CHECKS AGAINST MEDICARE DATA. | This rejection code is due to mismatch between Medicare card number and patient details. Please check card details with patient and resubmit with correct Medicare card number for this patient. |
| 9626 | THE PATIENT IS OR WAS COVERED UNDER THE RECIPROCAL HEALTH CARE AGREEMENT. | Patient has a reciprocal Medicare card which does not allow full access. Reciprocal Medicare card only allows public hospital benefits, Medicare will reject any private hospital claims. Please ask patient to contact health fund for cover review. |
| 9006 | THE PROVIDER IS NOT AUTHORISED TO PARTICIPATE IN ONLINE CLAIMING. CONTACT THE MEDICARE AUSTRALIA EBUSINESS SERVICE CENTRE FOR FURTHER ASSISTANCE. | Provider number is not authorised to participate in online claiming. Provider would have to contact Medicare ebusiness service to clarify please. |
| 8015 | Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number. | Medicare card number is incorrect, please check card details with patient and resubmit with correct Medicare number. |
| 8017 | Patient Verification has been accepted however patient details were not an exact match. Please check patient Given Name. | There is a first name discrepancy with Medicare. Please ask patient to contact health fund to ensure their first name matches Medicare first name exactly. |
| 8020 | Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and IRN. | Medicare card number and IRN are incorrect. Please check card details with patient and resubmit with correct Medicare number and IRN. |
| 8021 | Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Date of Birth. | This rejection code indicates Medicare card number and DOB are incorrect. Please check card details with patient and correct the Medicare number. For DOB, please ask patient to contact health fund to ensure their DOB matches Medicare. |
| 1326 | LABORATORY NOT ACCREDITED FOR BENEFITS AT DATE OF SERVICE | This rejection code is due to laboratory not being accredited for this date of service. Please contact Medicare to clarify pathology laboratory accreditation. |
| 1425 | BENEFIT NOT PAYABLE - INDIVIDUAL CHARGES REQUIRED | This rejection code indicates individual charges are required for item numbers. Please resubmit with individual charges. Do not combine charge. |
| 9649 | PATIENT ELIGIBILITY CANNOT BE DETERMINED. | Please ensure the correct membership number is used and it is an active policy. |
| 8003 | PATIENT IS CURRENTLY INELIGIBLE FOR MEDICARE. THIS STATUS CAN BE CONFIRMED FOR TODAY ONLY. | This rejection code indicates patient is currently ineligible for Medicare. Provider or patient can contact Medicare to clarify. |
| 3004 | THE REQUEST CANNOT BE DEALT WITH AT THIS TIME BECAUSE REAL-TIME PROCESSING IS NOT AVAILABLE OR THE SYSTEM IS DOWN. CONTACT THE MEDICARE AUSTRALIA EBUSINESS SERVICE CENTRE FOR FURTHER ASSISTANCE. | The system is down. Please wait and resubmit in a few days or send manually in the meantime. Alternatively, provider can contact Medicare eBusiness service centre. |
| 8022 | Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and note patient only has one name. | This rejection code indicates wrong Medicare card number and there is a name discrepancy with Medicare. Please check card details with patient and correct the Medicare number. For the name, please contact health fund to submit claim manually to Medicare. |
| 1442 | Patient not mymedicare registered with provider/practice | Patient not MyMedicare registered with provider/practice. |
| 8016 | Patient Verification has been accepted however patient details were not an exact match. Please check patient IRN. | Medicare IRN is incorrect. Please check card details with patient and resubmit with correct IRN. |
| 8019 | Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Given Name. | Medicare card number and first name are incorrect. Please check card details with patient and correct the Medicare number. For the first name part, please ask patient to ring health fund to ensure their first name matches Medicare exactly. Alternatively, provider can ask health fund to submit claim manually to Medicare. |
| 8018 | Patient Verification has been accepted however patient details were not an exact match. Please check patient Date of Birth. | This rejection code is due to DOB discrepancy with Medicare. Please ask patient to ring health fund to ensure their DOB matches Medicare. Alternatively, provider can ask health fund to submit claim manually to Medicare |