Unsuccessful Patient Claims

Fix unsuccessful claims and resubmit them to Services Australia.

About this task

Claims that were not processed because the patient is ineligible for a rebate are listed in the Pending_iconPending list. Users with the View Medicare exceptions and retransmit permission can open a claim, resolve any problems and retransmit the claim to Medicare.

Procedure

To update and resubmit a claim:
  1. Select Claiming, Banking, and Payments IconClaiming, Banking, and Payments > Patient Claims from the menu.
    Patient Claims
  2. In the Patient claims tab, select Pending_iconPending. All pending patient claims are displayed chronologically.
    Patient Claim - Pending list
    Filter the list of results by:
    • Visit Id - view particular visit ID and its associated claim ID.
    • Centre - if you have more than one centre, select the required centre from the list.
    • HCP - view the required HCP.
  3. To view the error details, for a patient claim, select it in the list.
    The claim details are displayed in the Visit panel - IconVisit panel.
    Record Visit panel
    Alternatively, locate the patient claim and hover the mouse over the Errors column or click the error message. Error message
  4. View and resolve the errors for the claim. For more information about error codes, see Medicare digital claiming return codes:
    • If the Re-transmit Claim field is disabled, hover the mouse over the Re-transmit Claim and view the eligibility conditions for the claim.
      Patient Claim eligibility
    • To view the patient claim summary, click Patient Claim Results. For more information, see Claim Summary.
    • If required, add additional codes and click Save.
  5. After you have resolved the errors, click Re-transmit Claim.
    You are redirected to the claim method selection panel.
    Retransmit the pending claims
  6. In the Refund/Claim method field, set the previous claim method Easyclaim (EFTPOS) or Medicare Online Claim.
    For the Medicare Online Claim method, if required, to send the contact details and bank details to Medicare, set Send contact details to Medicare and Send bank details to Medicare.
  7. Click Retransmit.

Results

Retransmitted claims are submitted to Services Australia again.

After the claim is successfully processed, it moves to the Transmitted claimsTransmitted list.

What to do next

If required, print the successfully transmitted claims from the Transmitted claimsTransmitted tab. For more information, see Print or Download Transmitted Claims.