Common data elements or fields used in Medicare Online and ECLIPSE claims to provide additional service related information to help streamline claims processing and payment timelines.
Table of common data elements
The table below outlines the common data elements or fields and the type of health professionals that may use them for their claims.
Different software packages may vary, including names and locations of fields in your practice management software (PMS) used to enter claiming data. Refer to your software vendor or software help guide for more information on data elements or fields and how you should use them for lodging claims.
|Data element or field||Description and usage||GP||Specialist||Radiology||Allied Health|
|Service text or Free text||Only to be used when additional information is required to support the claim for claim assessment purposes. Field limit of up to 50 characters with the exception of DVA which allows 100.
Refer to the table below on abbreviations for text fields.
|Number of patients seen||This is used to indicate the number of patients seen by the provider at a location such as patient visits to homes, hospitals, institutions or nursing homes. It must be used for group attendance items such as counselling.
If this information is not supplied at the time of claiming it will result in an overpayment of Medicare benefit.
|Duplicate service override indicator||Set values:
|Referral issue date||This is the date that the referral was issued or written by the referring provider. It must be in the format of DDMMYYYY.||No||Yes||Yes||Yes|
|Referral period type code||Set values:
|Referral override type code||Indicates why referral services were provided without referral from another provider.
Indicators or codes:
For ECLIPSE In-patient Medical Claims (IMC) claim types – Agreements (AG), Schemes (SC), billing agent Medicare and private health insurer (MB) or billing agent Medicare only (MO) are set, the referred within: <Facility Id> data will be automatically populated in the claim. You don’t have to enter these details in the service text.
For other online claim types this requires either the ‘hospital provider number (facility ID)’ or ‘the hospital name’ details in the service text.
|Request issue date||This is the date the request was issued or written by the requesting provider. It must be in the format of DDMMYYYY.||No||Yes||Yes||Yes|
|Request override type code||Indicators or codes:
|Self-deemed||There are 3 self-deemed codes:
All self-deemed diagnostic imaging services should be submitted without additional service text. If additional service text must be included then the text field should begin with 'Self Deemed'.
Must be used for Radiology and Radiation Oncology services - Medicare Benefits Schedule Group T2 services.
Used to provide:
Location Specific Practice Number (LSPN) - registered practice site or mobile equipment base identification number. LSPN is 6 numeric characters.
|Field quantity||May be used for Radiation Oncology services - Medicare Benefits Schedule Group T2 services.
Used to provide number of fields of treatment delivered to the treatment site.
If this information is not supplied at the time of claiming, it may result in an underpayment of Medicare benefit.
Abbreviations for text fields
Where additional information about a service is required, enter the abbreviation in place of the full description, where applicable.
Refer to your software vendor or software help guide on how additional information can be lodged for claims.
|HU2||Non-contiguous body areas|
|HU3||Contiguous body area with different setup required|
|HX1||Not for comparison|
|HX2||All x-rays specifically requested|
|HX4||Hand, wrist and forearm|
|HX5||Forearm and elbow|
|HX6||Elbow and humerus|
|HX7||Foot and ankle|
|HX8||Ankle and leg|
|HX9||Leg and knee|
|HXA||Knee and Femur|
- Education services for health professionals to access other education resources
- eBusiness Service Centre for enquiries about online claiming
- Online Technical Support (OTS) for Software Vendors for enquiries on:
- policy and procedures
- complaints and disputes
- feedback and suggestions
For more information on ECLIPSE refer to the Medical and Eligibility User Guide for Medical Practitioners - ECLIPSE
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