| 101 |
More details of service are required to assess benefit. |
| 102 |
No amount charged is shown on the invoice/receipt. |
| 103 |
A letter of explanation is being sent separately. |
| 104 |
Balance of benefit due to claimant. |
| 105 |
Benefit paid to provider as requested. |
| 106 |
The servicing provider is unable to be identified. |
| 107 |
Benefit paid on item number other than that claimed. |
| 108 |
The benefit is not payable for the service claimed. |
| 111 |
No benefit payable - service over 2 years old. |
| 113 |
The total charge shown on the invoice is apportioned over all items. |
| 115 |
Benefit recommended for this item. |
| 117 |
Benefit not recommended for this item. |
| 120 |
Age restriction applies to this item. |
| 122 |
Associated referral/request line not required. |
| 123 |
Benefit paid on radiology item other than service claimed. |
| 124 |
Item is restricted to persons of the opposite sex to patient. |
| 125 |
Not payable without associated operation/anaesthetic item. |
| 126 |
Service is not payable without radiology service. |
| 127 |
Maximum number of additional fields already paid. |
| 128 |
Benefit paid on associated fracture/amputation item. |
| 129 |
Service is not payable without the associated base item. |
| 130 |
A letter of explanation is being sent separately. |
| 131 |
Date of service not supplied/invalid. |
| 134 |
A single course of treatment paid as subsequent attendance. |
| 135 |
Provider not a consultant physician - specialist rate paid. |
| 136 |
Referral details not supplied - paid at GP rate. |
| 137 |
Details of requesting provider not shown on invoice/receipt. |
| 138 |
Benefit only payable when self-determined/deemed necessary. |
| 139 |
Approved pathologist should not use this item number. |
| 140 |
Non-specialist provider. |
| 141 |
No benefit payable for services performed by this provider. |
| 142 |
Letter of explanation is being sent separately. |
| 144 |
Claim benefit not paid - further assessment required. |
| 150 |
Member has not supplied details to permit claim payment. |
| 151 |
Associated service already paid - adjustment being processed. |
| 154 |
Diagnostic imaging multiple service rule applied to service. |
| 155 |
Letter of explanation is being sent separately. |
| 157 |
Service possibly aftercare - refer to provider. |
| 158 |
Benefit paid on associated abandoned surgery/anae item. |
| 159 |
Item associated with other service on which benefit payable. |
| 160 |
Maximum number of services for this item already paid. |
| 161 |
Adjustment to benefit previously paid. |
| 162 |
Benefit has been previously paid for this service. |
| 163 |
Surgical/anaesthetic item/s already paid for this date. |
| 164 |
Assistant surgeon benefit not payable. |
| 166 |
Letter of explanation is being sent separately. |
| 168 |
Not payable without associated operation/anaesthetic item. |
| 169 |
Operation/anaesthetic item not claimed. |
| 170 |
Assistant anaesthetic benefit not payable. |
| 171 |
Benefit not payable - provider may only act in one capacity. |
| 173 |
Patient episode coning - maximum number of services paid. |
| 174 |
Patient episode coning adjustment. |
| 175 |
Benefit paid on associated foetal intervention item. |
| 176 |
Pay each foetal intervention item as a separate item. |
| 177 |
Foetal intervention item paid using derived fee item. |
| 179 |
Benefit not payable - associated service already paid. |
| 184 |
Benefit paid for additional time item using a derived fee. |
| 194 |
Letter of explanation is being sent separately. |
| 195 |
Letter of explanation is being sent separately. |
| 206 |
Item number does not attract a benefit at date of service. |
| 208 |
Card number used has expired. |
| 209 |
Claimants name stated is different to that on card number. |
| 211 |
Patient not covered by this card number at date of service. |
| 212 |
Date of service used is in the future. |
| 214 |
Claim form not complete. |
| 215 |
Service claimed prior to 1 february 1984. |
| 217 |
Patient cannot be identified from information supplied. |
| 222 |
Benefit paid on associated anaesthetic item. |
| 223 |
Service not payable - specified item not claimed or present. |
| 225 |
Patient contribution substantiated - additional benefit paid. |
| 226 |
Date of service is prior to patient’s date of birth. |
| 227 |
Date of service prior to date eligible for medicare benefit. |
| 228 |
Date of service after benefit period for overseas visitor. |
| 229 |
Benefit paid at 100% of schedule fee. |
| 230 |
Combination of 85% and 100% of schedule fee paid. |
| 232 |
Service claimed not covered by medicare. |
| 233 |
Provider not entitled to benefit at date of service. |
| 234 |
Letter of explanation is being sent separately. |
| 236 |
Letter of explanation is being sent separately. |
| 237 |
Letter of explanation is being sent separately. |
| 238 |
Not paid because all associated services rejected. |
| 240 |
Gap adjustment to benefit previously paid. |
| 241 |
Total charge and benefit for multiple procedure. |
| 242 |
Service is part of a multiple procedure. |
| 243 |
Apportioned charge and total benefit for multiple procedure. |
| 244 |
Benefit not paid - service line in error. |
| 245 |
Benefit paid on service other than that claimed. |
| 246 |
Patient cannot be identified from information supplied. |
| 250 |
Explanation/voucher will be forwarded separately. |
| 251 |
Details of requesting provider not supplied. |
| 252 |
Service possibly aftercare. |
| 253 |
Radiotherapy assessed with other item number in claim. |
| 254 |
Assessment incomplete - further advice will follow. |
| 255 |
Benefit assigned has been increased. |
| 256 |
Item cannot be claimed as an in-hospital service. |
| 260 |
Benefit assessed with associated item on statement. |
| 261 |
Associated surgical items/anaesthetic time not supplied. |
| 262 |
Insufficient prolonged anaesthetic time - service not paid. |
| 264 |
Benefit not payable - compensation/damages service. |
| 265 |
Service not covered by reciprocal health care agreement. |
| 267 |
Service not payable - associated service not present. |
| 271 |
Not payable without associated ophthalmological item. |
| 272 |
Benefit paid on associated ophthalmological item. |
| 274 |
Provisional payment. |
| 280 |
Cannot identify service - resubmit with correct mbs item. |
| 282 |
Date of service outside of referral/request period. |
| 306 |
Card not valid at date of service - future claims may reject. |
| 307 |
Claim not paid - card number not valid at date of service. |
| 308 |
IVF service - conditions not met - no benefit payable. |
| 316 |
Benefit not payable - item cannot be self-determined. |
| 317 |
Benefit not payable - additional item to those requested. |
| 320 |
Quoted medicare card number is incorrect. |
| 322 |
Provider not approved for this medicare pathology benefit. |
| 325 |
Laboratory not accredited for benefits for this service. |
| 326 |
Laboratory not accredited for benefits at date of service. |
| 328 |
Benefit paid on associated tomography item. |
| 329 |
Not payable without associated tomography item. |
| 331 |
Benefit not payable – h.i.act sect 20(a)(1). |
| 332 |
Category 5 lab - benefit not payable for requested service. |
| 333 |
Provider must claim time-based items. |
| 334 |
Benefit not payable - associated pathology must be inpatient. |
| 335 |
Service is not payable without nuclear medicine service. |
| 336 |
Benefit paid on nuclear medicine item other than one claimed. |
| 337 |
Provider must claim content-based items. |
| 338 |
Provider not registered to claim benefit at date of service. |
| 339 |
Benefit paid at the concession rate. |
| 340 |
Refund of co-payment amount. |
| 341 |
No referral details - details required for future claims. |
| 342 |
Referral expired - paid at unreferred (GP) rate. |
| 343 |
Card number quoted for this claim has been cancelled. |
| 344 |
Concession number invalid - benefit paid at general rate. |
| 345 |
No safety net entitlement - benefit paid at general rate. |
| 346 |
Co-payment not made - $2.50 credited to threshold. |
| 347 |
Safety net threshold reached - benefit increased. |
| 348 |
Overpayment of claim - invalid concession number. |
| 349 |
Replacement for requested EFT payment rejected by bank. |
| 350 |
Hospital referral - paid at specialist/consultant rate. |
| 351 |
Benefit not payable - LCC number incorrect or not supplied. |
| 352 |
Service date outside LCC registration dates. |
| 353 |
Pathology items not present - no benefit payable. |
| 356 |
Documentation required to process service. |
| 358 |
Documentation not received - unable to process service. |
| 359 |
Documentation not received - unable to process claim. |
| 360 |
No benefit payable when requested by this provider. |
| 361 |
Di exemption - items not approved. |
| 364 |
Items must be claimed as a combination item. |
| 367 |
Service associated with mbac item in a multiple procedure. |
| 370 |
Benefit paid on item number other than that claimed. |
| 371 |
Future claims quoting old style card no will be rejected. |
| 372 |
Old style card number quoted - benefit not payable. |
| 373 |
Expired card - benefit not payable. |
| 374 |
Old card issue used - benefit not payable - also refer @. |
| 375 |
Service being processed manually. |
| 377 |
Number of patients seen not indicated. |
| 378 |
Provider cannot refer/request service at date of request. |
| 390 |
Documentation not received. |
| 391 |
Service provider on db1 differs from transmitted data. |
| 392 |
Benefit amount changed. |
| 393 |
No benefit payable - baby not an admitted inpatient. |
| 395 |
Tac medical excess. |
| 400 |
Equipment number missing or invalid. |
| 401 |
Benefit not payable - charge amount missing or invalid. |
| 402 |
Benefit not payable - number of patients attended required. |
| 403 |
Subsequent consultation - referral details required. |
| 404 |
Benefit not payable - referral/request details required. |
| 405 |
Equipment number invalid for servicing provider. |
| 406 |
Supporting text required to assess claim. |
| 407 |
Benefit not payable - overseas student. |
| 408 |
Date of service prior to 29 may 1995. |
| 409 |
Card number for this enrolment needs to be verified. |
| 410 |
Age restriction applies for this item - verify details. |
| 411 |
Mbac determination/precedent number not supplied or invalid. |
| 412 |
Benefit not payable - provider unable to claim this service. |
| 413 |
Benefit not payable - date of service prior to date of request. |
| 414 |
Provider practice location is closed at date of service. |
| 415 |
Referral details same as rendering provider - self-deemed? |
| 416 |
Services form a composite item - composite item required. |
| 417 |
Referral needed - if no referral, nr item to be transmitted. |
| 418 |
Item cannot be claimed more than once in one attendance. |
| 419 |
Benefit already paid on item - verify if multiple pregnancy. |
| 420 |
Operation/s schedule fee does not meet item description. |
| 421 |
Wrong assistant item used for the operation/s performed. |
| 422 |
Benefit paid has been reduced (benefit = charge). |
| 423 |
Optical condition not specified - no benefit payable. |
| 424 |
More information required - which eye was treated. |
| 425 |
Benefit not payable - individual charges required. |
| 426 |
Indicate whether new treatment or continuing management. |
| 427 |
Compensation related services - please forward documents. |
| 428 |
Date of service over 2 years - late lodgement form required. |
| 429 |
Patient cannot be identified from the information supplied. |
| 430 |
Conflicting referral details - please clarify. |
| 431 |
Initial consultation previously paid - query subsequent con. |
| 432 |
Not multi-op - more information required to pay benefit. |
| 433 |
Associated referral/request line not required. |
| 434 |
Expired or invalid card - benefit not payable. |
| 435 |
Service for nursing home care recipient - benefit not paid. |
| 436 |
Cannot claim out of hospital service through simp bill. |
| 437 |
Card details invalid - a new medicare number has been issued. |
| 438 |
Consultation and di item/s not payable on same day. |
| 439 |
Referring/requesting provider not in eligible area. |
| 440 |
Multiple echocardiogram services rule applied. |
| 441 |
Multiple echocardiogram and di services rules applied. |
| 442 |
Patient not mymedicare registered with provider/practice. |
| 443 |
Patient mymedicare registered with another provider/practice. |
| 444 |
Required eligible base item not present in the same claim. |
| 445 |
Benefit paid on associated base item. |
| 446 |
Total benefit for plastic and reconstructive procedure paid. |
| 449 |
Held EFT payment reprocessed - incorrect claimant selected. |
| 450 |
EFT details invalid - cheque issued for benefit. |
| 451 |
Service provided in an ineligible location. |
| 452 |
Resubmit claim for this service - image not claim related. |
| 453 |
Resubmit claim for service - claim details do not match image. |
| 454 |
Resubmit claim for service - some details not shown on image. |
| 455 |
Resubmit claim for this service - include account and receipt. |
| 456 |
No action required - line adjusted to process claim. |
| 457 |
No action required - line adjusted to process claim. |
| 458 |
No action required - benefit paid on adjusted claim. |
| 461 |
Adjustment to benefit previously paid. |
| 475 |
Patient/service details invalid or missing. |
| 500 |
Rejected in association with another item in this claim. |
| 501 |
Group attendance or item format invalid. |
| 502 |
Patient is not eligible to claim benefit for this item. |
| 503 |
Referral date format is invalid. |
| 504 |
Charge amount missing/invalid - no benefit payable. |
| 505 |
More information required - evidence of condition. |
| 506 |
Consultation not payable on same day as surgical procedure. |
| 507 |
Site not accredited for this service. |
| 509 |
Service paid as item 2712/2719. |
| 510 |
Service paid as item 52-96 or similar item. |
| 511 |
Emsn threshold reached - cap applied to benefit. |
| 512 |
Multiple musculoskeletal mri service rule applied. |
| 513 |
Multiple musculoskeletal mri and di services rules applied. |
| 514 |
Required equipment type code not on lspn register. |
| 515 |
Equipment is older than allowable age for this item. |
| 516 |
Benefit paid for base and derived radiotherapy items. |
| 517 |
Mpsn threshold reached - 80% out of pocket paid. |
| 518 |
Benefit paid at 100% schedule fee + emsn. |
| 519 |
Mpsn threshold reached - partial 80% out of pocket paid. |
| 520 |
Benefit paid at 100% schedule fee + part 80% out of pocket. |
| 521 |
Paid part 80% out of pocket + between 85% and 100% increase. |
| 522 |
Benefit paid - emsn + between 85% and 100% schedule fee. |
| 524 |
Safety net benefit adjusted. |
| 525 |
Only attracts benefit when claimed via bulk bill. |
| 528 |
Provider not in eligible area (incorrect rrma/ssd or state). |
| 529 |
Bulk bill additional payment item claimed incorrectly. |
| 530 |
Patient not on concession/under 16 years at date of service. |
| 535 |
Missing data. |
| 536 |
Location specific practice number not supplied. |
| 537 |
Location specific practice number invalid. |
| 538 |
Location specific practice number not recognised. |
| 539 |
Location specific practice num not valid at date of service. |
| 540 |
Enhanced primary care plan item not previously paid. |
| 549 |
Bulk bill incentive item already paid - adjustment required. |
| 550 |
Associated service not claimed - no benefit payable. |
| 551 |
Specimen collection point is incorrect or not supplied. |
| 552 |
Specimen collection point not valid at date of service. |
| 553 |
Approved collection centre number not supplied. |
| 554 |
Total benefit for anaesthetic service. |
| 555 |
Benefit paid on main rvg anaesthetic item. |
| 556 |
Rvg time item not claimed. |
| 557 |
Associated rvg anaesthetic service not claimed. |
| 558 |
Rvg anaesthetic item not claimed. |
| 559 |
Patient outside age range - please verify age. |
| 560 |
Rvg item restriction. |
| 561 |
Benefit paid on rvg item claimed. |
| 562 |
Benefit paid on associated rvg anaesthetic item. |
| 563 |
Associated rvg service already paid. |
| 564 |
Multiple vascular ultrasound services site rule applied. |
| 565 |
Multiple di and vascular ultrasound service rules applied. |
| 566 |
Total benefit for diagnostic imaging service. |
| 567 |
Benefit paid on main diagnostic imaging item. |
| 568 |
Item cannot be substituted. |
| 569 |
Provider unable to substitute. |
| 600 |
Requesting/referring provider unable to be identified. |
| 601 |
In-hospital services cannot be claimed as out-of-hospital. |
| 602 |
Out-of-hospital service cannot be claimed as in-hospital. |
| 603 |
Newborn not yet enrolled with medicare - no benefit payable. |
| 604 |
Service over 6 months old - late lodgement form required. |
| 605 |
Referral expired - no benefit payable. |
| 606 |
Referring provider number not open at date of referral. |
| 607 |
Referral date/period omitted or unable to be determined. |
| 608 |
Referring and servicing provider same - no benefit payable. |
| 609 |
Service/claim cancelled at provider’s request. |
| 610 |
Provider specialty not consistent with item claimed. |
| 611 |
Referral/request details not supplied - no benefit payable. |
| 612 |
Date of referral after date of service - no benefit payable. |
| 613 |
Card number cannot be identified from information supplied. |
| 614 |
No benefit payable - please notate time of each visit. |
| 615 |
Multiple procedures - notate times and area of treatment. |
| 616 |
Item cannot be claimed as an in-hospital service. |
| 617 |
Item cannot be claimed as an out-of-hospital service. |
| 618 |
No benefit if requested by this provider at date of request. |
| 619 |
Servicing provider number not open at date of service. |
| 620 |
Duplicate transmission - no further payment made. |
| 621 |
Item not claimable electronically. |
| 622 |
Pet drop-down items not claimable via EDI. |
| 623 |
Pet items only claimable via direct bill. |
| 624 |
Pet items - payee provider required. |
| 625 |
Payee provider not eligible to claim pet items. |
| 627 |
Pdt statement not provided by the doctor. |
| 629 |
Initial pdt therapy item not present on patient history. |
| 633 |
Refer back to the specialist (referring provider is closed). |
| 634 |
Refer back to the specialist (servicing provider is closed). |
| 635 |
Late lodgement not approved - letter being sent separately. |
| 636 |
Benefit reduced - dental cap broken. |
| 637 |
No benefit payable - dental cap reached. |
| 638 |
Derived fee and other item cannot be claimed in-hospital. |
| 639 |
Provider not in an eligible area to claim this item. |
| 640 |
More than one base and derived item claimed. |
| 641 |
More than one base item claimed. |
| 642 |
Benefit paid for derived and other item claimed. |
| 643 |
Derived item assessed with other item on statement. |
| 700 |
Benefit cannot be determined for this service. |
| 701 |
Benefit cannot be determined due to complex assessing rules. |
| 702 |
Item restrictive with another item. |
| 703 |
Duplicate of item already quoted. |
| 704 |
Provider not permitted to claim this item. |
| 705 |
No associated pathology service. |
| 706 |
Provider not associated with a pathology laboratory. |
| 707 |
Pathology laboratory not registered at date of service. |
| 708 |
Item cannot be claimed from this pathology laboratory. |
| 709 |
Another assistant item should be claimed. |
| 710 |
Associated surgical items not present. |
| 711 |
Unable to determine associated surgery. |
| 712 |
Base item not present or in incorrect order. |
| 713 |
Radiotherapy fields greater than maximum allowable. |
| 714 |
Benefit not determined - number ot time units not present. |
| 715 |
Number of time units exceeded maximum allowable. |
| 716 |
Service forms a composite item - composite item required. |
| 717 |
Benefit not payable on this service for a hospital patient. |
| 718 |
Provider location not open at date of service. |
| 719 |
Benefit cannot be calculated for hyperbaric oxygen therapy. |
| 720 |
Eligibility cannot be determined for this item. |
| 732 |
Referral period not valid for referring provider. |
