Medicare digital claiming return codes

When you lodge a claim for Medicare benefits, we use return codes to tell you why the claim was rejected or how the claim was assessed.

A return code includes a message about why your claim was rejected or how it was assessed. This information can be:

  • to identify any claiming errors
  • to make corrections
  • for your reference
  • to re-submit claims

Medicare return codes - 4 digit codes

We send 4 digit return codes when errors happen. The codes help you take action to claim.

Any messages returned relate to 1 of the following categories.

Function related - 1xxx or 2xxx

Functional errors:

  • when a condition, that’s not a data validation matter or assessing condition, is found by your digital claiming software, or
  • by environmental factors or coding errors within your software, including:
    • errors in the form
    • sequencing of functions calls including an attempt to use a non-existent client adaptor session with the incorrect session ID

Transmission - 30xx

Transmission errors as a result of environmental factors or coding errors within the software, include:

  • communication errors to a remote server
  • a remote server isn't available

Information messages - 52xx and 8xxx

The code for information messages are returned in the error code field.

Data - 70xx and 90xx

Data errors when you've:

  • provided a service date, set in the future
  • not given a postcode with a claimant address

When a report is available, you'll see one of these return codes:

  • 9501 - a submission response report is available
  • 9502 - multiple reports are included in the response

Other errors - 1999

The value will be 1999 when an error happens and there’s no return code.

Integrating return codes for Medicare Online and ECLIPSE

When you integrate the client adaptor application into your software:

  • some return codes are only available when these interfaces are combined
  • if successful, the action you should take when an error code is returned will depend on what’s appropriate for your client system
  • some errors will be resolved

Downloading 4 digit return codes into your programs

You can download the Medicare 4 digit return codes in a comma-separated values (CSV) format into your programs.

Open the CSV file as a variable width record in numeric and text where:

  • numeric is the reason code number
  • text is a short description

This file format doesn't include column headings.

Phone the eBusiness Service Centre to find out more about these codes.

Medicare reason codes - 3 digit codes

Medicare reason codes are 3 digit codes used in processing reports and in the Medicare statement of benefits. These codes provide information about how a claim was assessed.

We may reject a claim or give more information about:

  • a Medicare statement of benefits where an ‘@’ symbol on a claim was changed to match the current card issue number
  • the use of an incorrect Medicare Benefits Schedule (MBS) item
  • the patient getting the maximum allowable benefits for an MBS item
  • issues with eligibility of patients or health professionals
  • a benefit assessed with the associated MBS item on the statement
  • the need for extra details to assess the claim

Downloading 3 digit reason codes into your programs

You can download the Medicare 3 digit reason codes in a comma-separated values (CSV) format into your programs.

Open the CSV file as a variable width record in numeric and text where:

  • numeric is the reason code number
  • text is a short description

This file format doesn't include column headings.

Phone Medicare provider enquiries to find out more about these codes.

Other codes

Other Medicare reason codes include:

Page last updated: 18 May 2017

This information was printed Monday 29 May 2017 from humanservices.gov.au/health-professionals/enablers/medicare-digital-claiming-return-codes 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.