Medicare Easyclaim

Patients can claim their Medicare benefit and have it paid into their bank account through your practice’s EFTPOS terminal.

About

What you need to know

Medicare Easyclaim is used for Medicare bulk billing and patient claiming. It can be a stand-alone process via an EFTPOS device, or an integrated feature of your practice management software products. If you are using it for patient claims, you can start lodging claims for your patients once your EFTPOS provider installs it. For bulk billing, you’ll need to register your bank account details first.

Medicare Easyclaim is simple to adopt, requires minimal training and is easy to use.

You can use it 24 hours a day, 7 days a week. Your patients will receive their benefit almost immediately after swiping their EFTPOS card.

Key features

Some key features of Medicare Easyclaim include:

  • can be used for patient and bulk bill claims
  • no batching or storage required for bulk bill claims
  • single payment for health professionals bulk bill claims in 2-3 working days, direct into a nominated account
  • patient claims paid almost immediately into their bank account
  • more certainty with ‘pay doctor’ cheque - speeds up the process by lodging claims on the spot
  • no additional bank transaction fees, although standard EFTPOS charges still apply
  • concession verification - instant confirmation of patients’ concessional status
  • available to doctors, dentists, specialists and allied health professionals

Bulk bill claims

Follow the steps below to lodge bulk bill claims:

  1. the patient’s Medicare card is swiped through your EFTPOS terminal, or their details are stored in the integrated practice management software
  2. claim details are entered via the keypad or using the details stored in the integrated practice management software. Short-cut keys can be used for provider IDs and common item numbers
  3. the claim is sent to us for verification and an approval message is sent back to the terminal within seconds
  4. the patient then presses a button on the keypad to assign their Medicare benefit to you. The EFTPOS terminal will then print a patient receipt
  5. you receive a single payment into your nominated bank account in 2-3 working days. There is no need to batch or store claims

Paid patient claims

Follow the steps below for paid patient claims:

  1. the patient or claimant pays as usual, for example, cash, cheque, credit card or EFTPOS, and their Medicare number is entered, or their Medicare card is swiped through the practice’s EFTPOS terminal
  2. basic details are entered via the EFTPOS keypad or using the integrated practice management software. Short-cut keys can be used for provider IDs and common item numbers.
  3. the claim is sent to us for verification and an approval message is sent back to the EFTPOS terminal within seconds
  4. the patient swipes their EFTPOS card through the EFTPOS terminal and enters their PIN. If we accept the service, the benefit is paid directly to their bank account, almost immediately

Unpaid and part paid accounts

Follow the steps below for unpaid and part paid accounts:

  1. the patient’s Medicare card is swiped through the practice’s EFTPOS terminal, or their details are stored in the integrated practice management software
  2. claim details are entered via the keypad or using the details stored in the integrated practice management software. Short-cut keys can be used for provider IDs and common item numbers
  3. the claim is sent to us for verification and an approval message is sent back to the terminal within seconds
  4. if we accept the service, a pay doctor cheque will be sent to the patient, who brings it to the practice along with any outstanding balance

Financial institutions signed on to deliver Medicare Easyclaim

There are 5 financial institutions that have signed on to deliver Medicare Easyclaim:

More information

We work with peak medical bodies in each state and territory to help explain the choice offered by Medicare Easyclaim.

The eBusiness Service Centre can provide information about Medicare Easyclaim. 

There is assistance for accessing your bulk bill processing and payment reports through HPOS. You can change contact or practice details, as well as registration and amendments to banking details.

We can also provide you with information about the processing of data we receive.

A Business Development Officer can contact you to offer one-on-one, on-site visits and presentations about the system and discuss any issues.

Contact details are on Health Professionals contact information

Managing

Using Medicare Easyclaim

Things you need to know when using Medicare Easyclaim

Read more about using Medicare Easyclaim

Rejected claims

Patient privacy Patient privacy is protected. All information sent via EFTPOS is encrypted and sent through a secure network. As part of the accreditation agreement for Medicare Easyclaim, financial institutions are not permitted to collect, store or use any health claiming information.

Return codeInstructions
2015, 2025A system error has occurred. Please resubmit or call the eBusiness Service Centre and quote the error number displayed on the EFTPOS terminal
2016Item number missing. Please resubmit with this information
2017The payee provider cannot be the same as the servicing provider. Please check details and resubmit
20302 pieces of information submitted within the claim cannot be submitted together. Please check details and resubmit
2032Maximum reached. The maximum number of items that can be submitted in 1 claim is 14. Please create a separate claim if necessary
2038The referral or request information submitted is inconsistent with the item that is being claimed. Please check details and resubmit if appropriate
2053The patient contribution amount must be less than the total charge. Please check details and resubmit
2055The patient contribution amount should not be entered when the account is fully paid. Please check details and resubmit
3000-3999A system error has occurred. Please resubmit or call the eBusiness Service Centre and quote the error number displayed on the EFTPOS terminal
9006Check servicing provider details. May not be able to provide the service for this item at date of service. For more information, call the eBusiness Service Centre
9201Invalid data entered. Please check details and resubmit
9203Date of service is too old to be submitted through Medicare Easyclaim. Please issue patient/claimant an account/account receipt to claim through an alternative Medicare claiming channel. For example online, at a service centre or over the phone
9204The date entered is in the future. Please check details and resubmit
9207The item number claimed and an override code used cannot be used together. Please check details and resubmit or call the eBusiness Service Centre for help
9301, 9364The patient’s Medicare card number has not been entered. Please resubmit with this information
9302, 9364The patient’s reference number has not been entered. Please resubmit with this information
9305 The servicing provider details have not been entered. Please resubmit with this information
9306 Date of service has not been entered. Please resubmit with this information
9307 An item number has not been entered. Please resubmit with this information 
9308, 9310 The referring or requesting practitioner’s provider number has not been entered. Please resubmit with this information
9309, 9311, 9322 Please check the referral or request date entered
9312 The claimant’s Medicare card number or reference number has not been entered. Please resubmit with this information 
9316 The referring or requesting provider cannot be the same as the servicing provider. Please check details and resubmit 
9317 Please select if the account is paid or unpaid and resubmit 
9325 Service type has not been entered, e.g. diagnostic, GP. Please resubmit with this information
9326, 9332 Insufficient information entered to create the claim. Please submit with all information 
9338 Charge amount has not been entered or is invalid. Please check details and resubmit 
9427Item not covered for this patient at this date of service
9601The claim needs to be referred to a Customer Service Officer for further assessment. The claim will be processed and payment notification will be sent in the near future
9602This claim cannot be lodged through Medicare Easyclaim. Please issue patient/claimant an account/account receipt to claim through an alternative Medicare claiming channel. For example online, at a service centre or over the phone
9605Another Medicare card may have been issued to the patient or the details you entered do not match those held by the Department of Human Services (Human Services). Please update your records and resubmit the claim
9606Another Medicare card may have been issued to the claimant or the details you entered do not match those held by Human Services. Please update your records and resubmit the claim
9607This item is only claimable through bulk bill
9611Check item. The item claimed is either unknown or invalid at date of service, for example miscellaneous, incorrect alpha included. Please check details and resubmit, or issue patient or claimant an account/account receipt to claim through an alternative Medicare claiming channel. For example online, at service centre or over the phone
9618Either an amount has not been entered in the charge field or an invalid amount has been entered. Please check details and resubmit
9625Claimant’s address needs to be updated with Human Services. Issue claimant an account receipt to claim through an alternative Medicare claiming channel. For example online, at a service centre or over the phone
9630Please check the request or referral details
9631Check if service self deemed
9632Duplicate of service already paid. If not duplicate, resubmit with appropriate indication
9635Check servicing provider. May not be able to provide the service for this item at date of service. Please check details and resubmit
9638Claimant’s details required. Patient or quoted claimant is a minor
9641A restrictive condition exists
9643Check claimant name
9655A Location Specific Practice Number (LSPN) is invalid
9661This provider cannot substitute services
9678This service is not payable as an appropriate associated service is not present
9682Human Services cannot assess the request due to a system limitation. Please call the eBusiness Service Centre for assistance
9698Service is possible aftercare. Check the account and resubmit with a valid indicator if not normal aftercare
9699This item is not covered for this patient at this date of service. Please check details and if applicable resubmit or issue patient/claimant an account/account receipt to claim through an alternative Medicare claiming channel. For example online, at a service centre or over the phone
9700An incorrect item number appears to have been used or amount claimed does not match the item number. Please check details and resubmit
9701The maximum number of services for this item has been paid. If this service is not a duplicate, please resubmit with correct item numbers as per MBS
9702A base item has not been entered or should be entered first. Please resubmit with correct sequence
9703The item number used cannot be claimed for this provider. Check details of service and resubmit with appropriate item
9704This service appears to have been previously claimed. Please call Human Services if you would like to discuss
9705In some instances where two or more services are performed together, they are claimable under one item number. Check the MBS for correct item and resubmit. If exceptional circumstances exist, issue claimant an account/account receipt noting reasons for separate items. Claimant must claim through an alternative Medicare claiming channel. For example online, at a service centre or over the phone
9706This item requires a specific notation of the relevant condition. Check the MBS and resubmit through an alternative Medicare claiming channel. For example online, at a service centre or over the phone
9707This claim needs to be referred to a Customer Service Officer for further assessment. Please issue claimant with an account/account receipt to claim through an alternative Medicare claiming channel. For example online, at a Service Centre or over the phone
9708 Equipment number entered does not appear to be registered with Medica Please check details and resubmit
9709 An age restriction applies to this item. Please check the MBS to verify item specifics
9710 This item number has specific restrictions. Refer to the MBS and ensure you are entering the correct patient details 
9711 This claim requires further assessment by a Customer Service Officer. Please issue claimant with an account/account receipt to claim through an alternative Medicare claiming channel. For example online, at a Service Centre or over the phone 
9712The item number claimed and an override code used cannot be used together. Please resubmit the claim or call us for assistance
9765 Site not accredited for this service 

Reconciling payments

You should choose the claiming option, or combination of options, that best suit your business needs. One thing you should consider in making this choice is how you reconcile bulk bill claims, or how you would like to.

For Medicare Easyclaim operating as a stand-alone solution, you obtain your bulk bill processing and payment reports through Health Professional Online Services (HPOS) . You then download and print a PDF or Excel file and reconcile this report against your claims. Due to the information contained in these reports, their size and the need to print the reports, it is not possible to retrieve these via the EFTPOS terminal.

There is no requirement for you to reconcile patient claims in either Medicare Online or Medicare Easyclaim. You could therefore choose to use Medicare Online for bulk bill claims and automatic reconciliation. Then use Medicare Easyclaim for patient claims and real-time payment of patient benefits.

Automatic reconciliation

Automatic reconciliation is available for financial institutions to integrate with the Medicare Easyclaim solution through their practice management software.

Medicare Easyclaim processing and payment reports

Bulk bill processing and payment reports provide information about Medicare Easyclaim and the services within that claim.

Read more about Medicare Easyclaim processing and payment reports

Reference guide

Helpful tips

When using Medicare Easyclaim:

  • allied health professionals must ensure they have a Medicare provider or registration number before transmitting claims
  • for a patient to assign their benefit for bulk bill claims, it is a legal requirement to press OK on the EFTPOS terminal, or to sign an approved DB4 form if the EFTPOS terminal system is unavailable
  • bulk bill claims transmitted and assessed for payment by 5:30 pm Australian Eastern Standard Time will be paid in 2-3 working days for health professionals who have bank details registered with us
  • health professionals need to have their bank account details lodged with us to receive bulk bill payments
  • a general practitioner (GP) consultation and a diagnostic item or items can be transmitted in 1 claim, as long as the items are non-referred or requested services, and the servicing provider is qualified to perform those services
  • if the EFTPOS terminal times out or there is a communication failure, the practice should issue an account or account receipt to the patient or claimant to receive their benefit through Medicare Online, by phone or at a Medicare Service Centre
  • the AP override code, not duplicate service am-pm, is not required for Concession Entitlement Verification (CEV) items. For example, when claiming item 23 and CEV item 10990, it is not necessary to use the override code of AP for the CEV item
  • the AP override code should only be used when claiming a 2nd visit using the same item number for a patient on the same day, for example, item 23 is rendered twice on the same date of service at separate visits

Services not accepted through Medicare Easyclaim

Items not accepted through Medicare Easyclaim:

  • in-hospital items
  • Australian Childhood Immunisation Register information
  • bulk bill claims more than 2 years from date of service
  • patient claims more than 2 years from date of service
  • time-duration-dependent items
  • notional charges, for example, a health professional has raised a total charge to cover a group of services
  • patient claims for pathology items, except Group 9 items
  • bulk bill pathology items that are self-deemed or Rule 3 exemptions
  • patient claims and bulk bill claims with non-standard referrals
  • items where the charge exceeds $9,999.99
  • GP multiple attendance items, for example, Medical Benefits Schedule (MBS) item 24, 35, etc
  • separate sites override, unless the item is listed under Restrictive override code in the ‘General terms explained’ list below
  • assisted reproductive technology services
  • claims requiring text

These items may be claimed through Medicare Online, by phone or at a Medicare Service Centre.

More information can be found at claiming choices

Call the eBusiness Service Centre to:

  • obtain help accessing your bulk bill processing and payment reports through Health Professional Online Services (HPOS)
  • change contact or practice details
  • organise an on-site visit by a Business Development Officer

For technical problems, call the financial institution that supplied the service.

Medicare Easyclaim terms

Allied Health professionals

  • Aboriginal Health Workers
  • audiologists
  • chiropodists
  • chiropractors
  • dentists
  • dental specialists, non-Medical Benefits [Dental Practitioners] Advisory Committee
  • diabetes educators
  • dieticians
  • exercise physiologists
  • mental health nurses
  • occupational therapists
  • oral medical and pathology practitioners
  • osteopaths
  • paedodontists
  • periodontists
  • physiotherapists
  • podiatrists
  • prosthodontists
  • psychologists
  • social workers
  • speech pathologists

Any Medicare Benefits Schedule item lodged for services provided by the above should be accepted, unless restrictions are applied, for example, a care plan MBS item is not present on the patient’s history, or the maximum number of services have been performed.

Cancel (bank initiated)

An auto-cancel will be initiated when a financial transaction has been transmitted but no response has been received within the timeout period.

Claimant

The person who incurred the expense for services provided. The claimant is not always the patient, for example, a parent.

Claimant Medicare card number

The claimant must have a valid Medicare card number in order to transmit patient claims through Medicare Easyclaim.

Date of service

The date of service will be automatically generated as the date the claim is created and transmitted.
In circumstances where the date of service is different to the date the claim is being transmitted, the date of service must be manually entered and must:

  • be in the format DDMMYY
  • be a valid date
  • not be in the future
  • not be more than 2 years old

Diagnostic imaging

Request details may be required with diagnostic imaging services.

Equipment identification number

The identification number (allocated by the Department of Health) of specific equipment that needs to be registered in order to claim certain items. This commonly applies to radiotherapy equipment.

Item override code

 Under certain circumstances, health professionals need to give more information on an account so that a service can be assessed. The item override code will allow you to submit the extra information for a specific situation. If you leave this information out when it is needed, it will result in rejection.

  • AO = not normal aftercare
  • AP = not duplicate service (am-pm)

Location Specific Practice Number (LSPN)

The LSPN is applicable to services:

  • within Group T2 - radiation oncology services as described in the MBS
  • within Category 5 - diagnostic imaging services as described in the MBS
  • where a general practitioner has remote area exemption and performs diagnostic services

Where these services occur, this field is considered mandatory.

Medicare card flag values

An indicator that shows the problem we have with the submitted Medicare card. This indicator may appear on the bulk bill processing report against a claim.

  • A = patient identification amended
  • I = patient Medicare issue number changed
  • C = patient Medicare number changed
  • W = patient card used will expire shortly
  • S = patient card expired. Future services may be rejected
  • X = old Medicare issue number for patient, future services may be rejected

MBS item number

The MBS item number is required for each service. It must be valid at the date of service for that health professional. Miscellaneous taxable services and ancillary items that do not attract a Medicare benefit cannot be entered. View the MBS online

Pathology

Pathology services provided by an eligible health professional, including Group 9 for patient claims.

Patient

Identifies the individual who receives the services.

Patient Medicare card number

The patient must have a valid Medicare card number to transmit patient or bulk bill claims through Medicare Easyclaim.

Patient Individual Reference Number (IRN)

The IRN is on the left of the patient’s name on their Medicare card.

Payee provider number

Provider number of the health professional who is to be paid for the service. Only required if the payee provider is not the servicing provider.

Pended claim

Claims that need a Customer Service Officer to manually review due to complexity or special circumstances.

Real-time Medicare eligibility validation

We will validate the patient’s eligibility when the claim is lodged.

Referral details

Required for certain services provided by specialists, allied health professionals or consulting physicians, where a Medicare benefit is dependent on acceptable evidence that the service has been provided following referral from another health professional.

Referral details for initial consultations and other referred services (including subsequent consultations) are mandatory.

The referring provider must have a current and valid registration at the date of referral.

Referring provider number

The provider number, allocated by us, of the referring provider.

Referral issue date

This field must be keyed if referral details are given. The date keyed is the date on the letter of referral.

Referral period type code

Indicates the period of referral. This field must be entered if you have entered a referring provider number and referral issue date.

Values

  • S = standard (12 months from a GP and 3 months from a specialist)
  • I = indefinite

Referral override type code (specialist services only)

Indicates why referred services were provided without referral from another health professional.

Lost or emergency referral indication

This data is only needed in cases where a written referral was lost, or in the case of an emergency situation where the servicing provider believed the service needed to be given as quickly as possible.

Lost and emergency referrals are applicable to initial consultation items only. All referral requirements must be met for following consultation items.

  • L = lost
  • E = emergency
  • N = not required may need to be entered where referral details are not required

Request details

Required for items that are subject to the written request requirement and are classified as R-Type (requested) services in the MBS.

The following data is required

  • requesting provider number
  • request issue date

Requesting provider number

The provider number, allocated by us, of the requesting provider.

Request issue date

Date the request was issued.

Request override type code

Lost or emergency request indication

Required where a written request was lost, or in the case of an emergency where the servicing provider believed the service needed to be rendered as quickly as possible.

The requesting provider must have a current and valid registration at the date of request.

Values

  • L = lost
  • E = emergency
  • N = not required (for bulk bill pathology only)

Restrictive override code

Under certain circumstances, providers need to give more information on an account to allow assessment of a service. If the information is left out, it will be rejected or the practice will be contacted for more details. The restrictive override code enables health professionals to send the extra information, for specific situations, through a 2-character indicator for correct assessment and payment for the service.

Separate sites - when this indicator is set, item numbers 30071, 30061, 30192 and 30195 will automatically override where

  • the services are within 1 claim and are for the same patient, health professional and date of service
  • there are combinations of items 30071 and 30061 plus only 1 x 30195 or only 1 x 30192
  • there are multiples of items 30071 and 30061 within 1 claim

The time-dependency restrictions for items 30192 and 30195 will continue to apply.

Values

  • NC = Not for comparison
  • SP = Separate sites
  • NR = Not related (care plans for allied health)

Specimen collection point identification number (SCP ID)

For bulk bill pathology services only. The provider number is used along with the SCP ID for assessment of the claim. The claim will be rejected if the provider number used is not registered in the Medicare system to allow that provider to perform services with the SCP ID entered.

Self deemed code

SD is an optional element. However, conditions apply depending on the SD value selected. SD applies to both pathology and diagnostic claims. When the SD value is present, request details cannot be set.

Pathology claims may only have an SD indicator.

SS only applies to diagnostic claims.

When the SS value is present, request details are required.

There may be claims where neither the request details nor request override type code are set; instead, a self-deemed value of SD applies.

  • SD = self deemed
  • SS = substituted service

Servicing provider number

Provider number of the provider who rendered the service.

Types of EFTPOS receipts

The EFTPOS terminal will produce the following types of receipts, which must be given to the patient or claimant.

  • Medicare patient claim receipt - for all fully paid, assessed patient claims
  • Medicare lodgement receipt - for all unpaid, partially paid or pended patient claims
  • Cancelled Medicare claim receipt - for all patient claims that have been cancelled by the medical practice or claimant
  • Bank cancelled claim receipt
  • Bulk bill assignment advice - for all bulk bill claims following acceptance of the claim by the medical practice and assignment of benefit by the patient

Patient claim definitions

Patient claims

Medicare patient claims lodged by a patient or claimant who has received professional medical services for items covered under the MBS.

Cancel indicator

Where we have assessed the claim and shown a benefit amount. The claimant may not have a bank debit card, or the card cannot be read by the EFTPOS terminal, or the claimant does not wish to continue with the claim. In these cases, the practice cancels the claim.

Rejected claims

Where we are unable to assess a patient claim immediately, the claim will be returned to the practice site via the EFTPOS terminal with a 4‑digit return code.

The 4 digit return code is to help the health professional to resubmit the claim with changes, if appropriate, allowing a successful transmission. Alternatively, these claims may be lodged through an alternate channel. Refer to the list of return codes.

Real time patient claim

Real-time processing by Medicare Easyclaim transmits, assesses and returns an outcome to the sending location as a single process.

Lodgement of a real-time Medicare Easyclaim patient claim requires specific information to be entered into the claim while the patient or claimant is present.

Types of patient payment options

There are 3 payment options for patient claims that can be lodged through Medicare Easyclaim. The type of claim submitted is dependent on how the patient or claimant and the health professional have chosen to settle the account.

  • Fully paid account - patient or claimant has paid their account in full with the health professional
  • Part paid account - patient or claimant has paid a contribution toward the settlement of the account
  • Unpaid account - account has not been paid

Types of benefit payment

The payment method for claims lodged through Medicare Easyclaim depends on whether the account is fully paid, part paid or unpaid.

Fully paid: where the account has been paid in full, payment will be made to the claimant’s nominated bank account almost immediately. This payment will be initiated by the claimant swiping their EFTPOS card.

Part paid: where a claimant has made a part payment contribution towards the account.

Where Medicare benefits are assessed as payable for a claim, a statement or cheque in the health professional’s name will be sent to the claimant’s address recorded by us. The cheque is then sent by the claimant to the health professional with any outstanding balance. Where no benefit is payable, a statement will be sent to the claimant’s address recorded by us.

Where a Medicare Safety Net threshold has been reached and the patient is entitled to an additional safety net benefit, the amount will be either paid by cheque to the claimant or by EFT if this information is stored by us.

Unpaid: where the account is unpaid. Where Medicare benefits are assessed as payable for a claim, a statement or cheque in the health professional’s name will be sent to the claimant’s address recorded by us. The cheque is then sent by the claimant to the health professional with any outstanding balance. Where no benefit is assessed as payable, a statement will be sent to the claimant’s address recorded by us.

Bulk bill claim definitions

Bulk bill claims

A bulk bill claim is where a patient who is eligible for a Medicare benefit assigns their right to the benefit to the servicing provider as full payment for that service and the health professional lodges the claim with us.

It is at the health professional’s discretion whether or not to bulk bill a patient.

Accept or decline indicator

Where a Medicare eligibility or concession entitlement is returned by us, the medical practice or patient may choose to accept or decline the claim.

Assignment of benefit

When a patient assigns their right to the benefit to the servicing provider as full payment for those services.

Benefit assigned amount

For Medicare Easyclaim, the benefit returned in a bulk bill claim refers to an estimate of the benefit that the health professional will be paid.

This amount may be adjusted in accordance with the rules set out in the MBS.

Claims per transaction

Only 1 bulk bill claim can be submitted per transmission. This claim may contain more than one service item.

Real time Concession Entitlement Verification (CEV)

When the bulk bill claim is lodged, we will validate the patient’s concession entitlement only if the patient’s Medicare card is valid.

Retention of records

We recommend practices keep all records associated with benefits paid for at least 2 years. These records can include electronic billing information, notes in practice software, appointment records and assignment of benefit forms. In the event of an audit, this information will help health professionals to validate to us that claims have been correctly paid.

Transmission of bulk bill claims

Bulk bill claims are transmitted to us in real time but are not assessed immediately.

Basic patient or provider eligibility checks occur before the patient and provider accept or decline the assignment of benefit. The patient must be present to press OK to assign their benefit.

The receipt that is printed is an Assignment of Benefit Advice only and indicates that the claim has been successfully transmitted to us.

The practice must give the patient a copy of the receipt.

This information was printed from humanservices.gov.au It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.