Medicare Error Codes - Full List and Who to Contact

Medicare Error Codes are returned when there is a problem with a submission.

The complete list of codes can be accessed at 4 digit response codes

Please see the list attached for a brief explanation of each code.

Full List of Medicare Error codes

A full list can be found on the Medicare website:

http://www.medicareaustralia.gov.au/provider/vendors/reason-codes/4-digit-codes.jsp#N10047

Contacting Medicare or the Health Fund

The next action to take after receiving an error depends on the error itself.

  • Most errors will require you to go back into The Specialist to fix the problem and then resubmit the invoice/batch/claim.
  • Some errors will require that you contact Medicare:
    Medicare Claim Queries - 1800 700 199
  • Some errors will require that you contact the health fund in question

Remember, that with Online claiming you still need to do the normal checks and balances that you did when you were submitting to Medicare via the old paper based method.

Our system applies a strict set of rules defined by Medicare that stop errors at the transmission phase so you need to ensure all the relevant information is attached to the patient/invoice BEFORE submitting it.

Rejections due to Time not being sent to Medicare.

In some instances, Medicare will need to know the time that service was delivered and will reject the claim if this information is not provided.

In these cases, when raising the invoice:

  • The check box must be ticked next to the Time box
  • The time needs to be entered into the Time box

Medicare Error code 1008 - EFT Details have not been registered with Fund

The health fund does not have EFT bank details registered for the minor ID being used.

Solution

Contact the health fund and get your Medicare minor ID updated on their records.

Medicare Error code 1711 - PROTOCOL EXCEPTION

An error 1711 (protocol exception) almost always means a problem
at the Medicare end, and is caused by a momentary communications
fault caused by their servers OR your Internet connection.

RESOLUTION:

Often a resubmission later in the day will get around this.

Medicare Error code 2023 - The report is not available yet or is no longer available for retrieval

This error means that the report you have requested is not yet available from Medicare.
This is not a system error - it's just that the information has not yet been made available by Medicare.

RESOLUTION:

You will need to wait until the report is available.
If you feel you have been waiting for an excessive period of time for the report then we would advise contacting Medicare.
They will probably need the eventID associated with the request so go armed with that information.
Please do not log this issue with Clintel as there is nothing we can do as this is a medicare issue.

Medicare Error code 2030 - 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.

The error you have quoted relates to Two pieces of information submitted within the claim cannot be submitted together. Please check details and resubmit.

RESOLUTION:

The error above is a Medicare error, so if you can't identify which items are incompatible, call Medicare and let them know the items that you are trying to submit together.
Then they should be able to assist you. You will probably have to submit the items separately.

The following link may be useful for resubmitting the claim:

Guide on Resubmitting rejected invoices:
http://redmine1.healthsolve.com.au/projects/cthdkb/wiki/ECLIPSE_Online_-_Resubmitting_Rejected_Invoices

Medicare Error code 6902 - Use Alternative Claiming Channel

"The Claim cannot be lodged through Medicare EasyClaim. Please
issue patient/claimant an account/account receipt to claim
through an alternative Medicare claiming channel
(e.g. at a Medicare office)."

This is a generic error.

The Patient has to go into Medicare to resolve.

Issue at Medicare’s end not the client or vendor

ECLIPSE > Error code 9376 - Facility ID or Treatment Location Provider No must be supplied

A missing Hospital Provider Number for a service location is probably the cause of this issue.

Solution

Service locations have their own Hospital Provider Numbers, it may be that these have not been added.
Please note: this is not the doctor's provider number.

To add the hospital provider number:

  1. Click Setup
  2. Under the Main tab click Service Locations
  3. From the list of service locations on the left, either double click, or select the location then Blue Triangle, to edit.
  4. Under Provider Details, fill in Hosp Provider No.
  5. Green Tick to save

You should then be able to resubmit the claim.

Medicare Error code 9380 - Claim Type has been identified as a Gap Cover scheme, Informed Financial Consent must also be identified as being supplied in writing for the patient or indicated as not obtained

This is caused by having Medibank Private claim and correcting the claim type but not setting the IFC for the line items

Solution

  1. Go to Enquiries for the account and look at the Summary view
  2. Select the problem invoice and click the 'Details' button'
  3. Click the 'Edit Invoice Values' link and set the claim type to 'Scheme' and save change
  4. In turn, select each item that appears in the list at the top of the window, click the 'Edit Line Item Values' link and set the IFC to 'Not Obtained'

Medicare Error code 9601 (PCI) - The claim needs to be referred to a Medicare Customer Services Officer for further assessment. The claim will be processed and payment notification will be sent in the near future.

This normally means that you need to "push" the claim through.

If you go through the steps in the Patient Interactive Claims guide you should be able to successfully send the claim:
http://redmine1.healthsolve.com.au/projects/cthdkb/wiki/Patient_Interactive_Claims

The key is ticking the box - show below:

Medicare Error code 9602 - This claim cannot be lodged through Medicare Easyclaim. Please submit the claim via an alternative Medicare claiming channel.

There is no problem with the system, this is a standard message from Medicare Australia.
For some reason the claim cannot be processed using the online system.

Resolution

Contact Medicare Australia to find out how they would like you to submit the claim.
They may suggest that it is submitted manually as a paper submission.

Medicare Error code 9624 - A subsequent consultation has been keyed and the date of service is after the referral expiry date

The referral attached to the invoice had expired at the date of the subsequent consultation.
This can often happen when indefinite referrals have been incorrectly entered into Medicare's database as a standard referral, by Medicare Australia.

Next actions:

  1. Client should contact Medicare to confirm that the indefinite referral has been entered as a standard referral, if this is the case:
  2. Short Term: Submit the claim(s) manually so they can be processed by Medicare
  3. Long Term: Get a new referral for the patient(s) and then you will be able to submit subsequent claims electronically. The Specialist will allow you create a new referral as long as the date of referral is before the date of service delivery.

Error Code: 9641 A restrictive condition exists

This is an advisory error which normally means that you need to "push" the claim through.

The key is ticking the box - show below:

Once it has been submitted, the status should change to "Referred".

Full PCI instructions can be found here:
http://redmine1.healthsolve.com.au/projects/cthdkb/wiki/Patient_Interactive_Claims

Medicare Error code 9662 - PROVIDER MUST CONTACT FUND

First check the Medicare online status page and see if the Health funds are available:

http://www2.medicareaustralia.gov.au/pext/ECLIPSEMonitor/external/eclipse_status.jsp

While this is often not up to date, at the time of checking if it appears that Medicare's communication with the health funds are down this may be the cause of this issue.

Possible causes of this error

Normally, the issue is a result of:

A) Medicare can't deal with the request at this time - possibly due to Medicare being unable to commuincate with the health funds due to an error at their end
or
B) This claim can't be dealt with online and you need to contact the fund for further information

Who should you contact?

First contact the health fund to see if there are any issues at their end relating to the claim.
Then contact Medicare as it may be a technical error at their end.

Medicare Error code 9672 - Fund List Out of Date

This is often caused by having an incorrect guarantor code in The Specialist.

The Guarantor code must match the fund code in CareRight Platinum.

Solution

Please see the ECLIPSE SETUP INSTRUCTIONS to help you fix up your guarantor codes in
The Specialist so they match what is present in CareRight Platinum:

http://redmine1.healthsolve.com.au/projects/cthdkb/wiki/Eclipse_Setup

When this is fixed up resubmit the invoice.

medicare-easyclaim-return-code-list.pdf - Medicare Error Codes (151 KB) Mike Hall, 22-06-2012 03:18 PM

message 9602.jpg (15 KB) Mike Hall, 10-01-2013 09:41 AM

medicare-easyclaim-return-code-list.rtf (836 KB) Mike Hall, 30-08-2013 11:07 AM

time entry.png (32.4 KB) Mike Hall, 10-10-2013 12:25 PM