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. You can use this information:

  • to identify any claiming errors
  • to make corrections
  • for information purposes only
  • to re-submit for payment

Medicare return codes - 4 digit codes

We send 4 digit return codes when errors occur. The codes help you decide what action you should take for your digital claiming.

Any messages returned relate to 1 of the following categories.

Function related – 1xxx or 2xxx

Functional errors are caused:

  • when a condition that is 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 occur as a result of environmental factors or coding errors within the software, including:

  • communication errors to a remote server
  • a remote server is not available

Information messages – 52xx and 8xxx

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

Data – 70xx and 90xx

Data errors occur when you have:

  • provided a service date, set in the future
  • failed to provide a postcode with a claimant address

When a report is available, you will see one of these return codes

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

Other errors – 1999

When an error occurs and no return code is available the value will be 1999.

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 is 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 with spreadsheet software as a variable width record in numeric text where:

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

This file format does not 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 provide additional 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 MBS item
  • the patient receiving the maximum allowable number of benefits for an MBS item
  • issues with eligibility of patients or health professionals
  • a benefit assessed with the associated 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 with spreadsheet software as a variable width record in numeric, text where:

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

This file format does not include column headings.

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

Other codes

Other Medicare reason codes include:

Page last updated: 28 January 2016

This information was printed Tuesday 9 February 2016 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.