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Medicare and DVA Error Messages

Samantha
Updated

When using Medicare and DVA Online Claiming, claims might be rejected or receive error messages. If this is the case, a message in the Invoice History will suggest looking for the error message details.

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There are 2 ways to find the error message:

 From the invoice

1. Click on Online Claims at the bottom of the invoice.

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2. Click on Claims tab.

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From the Report

1. Go to the Reports section.

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2. Click on Medicare under Financials.

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3. Enter your Date Range and other required parameters and Click Generate Report.

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Error Messages

Below is a list of the most common error messages and how you can rectify the error to successfully claim when resubmitting the invoice.

Provider Number should be 8 characters long: The provider number of the staff member is wrong.

  • Change the provider number on the invoice - Select item >  Change Provider > Change Provider number > Click save. Resubmit Claim (Reset).

 

Must have no more than 5 characters: This refers to the item service code of the Services, it needs to be the code only with nothing else (e.g. PH10, not DVA - PH20)

  • Change the item number on the invoice - Click on item > Click Edit Service Code > Click Save.
  • Change item code for the Service for future invoices - Practice > Setup > Services > Click on Service > Change item Code > Click Save.

 

 (Referring Provider No.) The provider number failed validation checks (the provider number is incorrect): The provider number of the referring Doctor is not valid.

  • The wrong referrer might have been chosen while submitting the invoice - Check the Referrer number in the Claim tab, if this is the case, select the appropriate referrer when resubmitting the invoice.
  • The Doctor provider number in the Contacts section might be wrong - update it in Contacts > Select Doctor > Change provider number > Click Save.

 

Cannot register Location based on transaction type: Different issues can cause this error but usually it relates to the wrong provider number used for the claim or the invoice.

  • If the provider number selected when generating the invoice is wrong - Change the provider number for the item (Select Item > Click Change provider > Select appropriate provider number > click Save).
  • If the provider number was wrong when submitting the invoice, select the appropriate provider number to resubmit the invoice.

 

Must be after Patient's Date of Birth and be before today and be before [item.date]: It relates to the different dates used to process the claim:

  • The Client Date of birth of the Client might be wrong or missing in the Client Profile - If this is the case, update Client DOB in Client Details.
  • The invoice date might be before the date the item was invoiced. If so, change the date of the invoice to be the same or later than the most recent item invoiced - Click on the invoice date > Change Date > Click Save.
  • The item date or the invoice date is in the future, correct the appropriate date - Select item > Click Edit Date > Change Date > Click Save.

 

An identical claim has already been submitted: The same invoice is already pending or an invoice with the same item date has already been submitted.

  • Reset the pending claim instead of filing a new claim (can be reset once the claim has been submitted for 72 hours without receiving an update).

 

Maximum number of services for this item already paid: The number of session approved for this claim has been reached. If you think this is not the case, contact Medicare of DVA.

 

Benefit has been previously paid for this service: A claim for an item invoiced on the same date has already been paid.

  • Check the item date is correct
  • Verify if a previous invoice has a wrong item date.
  • Change the relevant date and submit the invoice again.

 

No benefit if requested by this provider at date of request: The Referral is expired or the Referrer provider number has not been updated.

  • Update the Provider Name and Provider Number in the Case to match the new Referral. We recommend creating a new Case for new referral or you might need to delete the previous referral, save the changes and add the new referral.

 

Provider cannot refer/request service at date of request OR Referring provider number not open at date of referral: The Referrer Provider Number has changed.

  • Update the Provider Number of the Referrer in your Contacts and resubmit the Claim with the new Provider Number.

 

Old card issue used - benefit not payable: The Card is expired

  • Update the Medicare or DVA card details in Clients > Health section and resubmit the claim.

 

Minor ID [minor id] is not yet linked for electronic claims. Contact your application support for assistance: This is generally a provider number and minor ID issue.

  • The "Not Yet Linked" error generally occurs where the Payee or Servicing Provider Number hasn't been fully or correctly set up with the Medicare Location / Minor ID. The first step we advise taking is to note down the following details:
      1. The Location / Minor ID - it can be found in Setup > Connections > Integrations > Medicare: Configure - and will be in a format such as: SAP123456.
      2. The Payee Provider Number - it can be found in Setup > Connections > Integrations > Medicare: Configure - please note: it is optional, so it may not be set.
      3. The Servicing Provider Number - it can be found in Reports > Financials > Medicare - and will be found in the same record as the "Missing Rejection Code" error.
      4. The Invoice Item Date - it can be found on the Invoice.
  • Once you have that information, place a call to Medicare support on 13 21 50 and ask the following: "Could you please confirm that the Provider Number [insert Servicing Provider Number here] is connected to my Location / Minor ID [insert Location / Minor ID here] as of the date [insert Invoice Item Date here]?"
  • If you had the optional Payee Provider Number set: "Could you also confirm that my Payee Provider Number [insert Payee Provider Number here] is connected to my Location / Minor ID [insert Location / Minor ID here] as of the date [insert Invoice Item Date here]?"
Important
Medicare staff may be unable to see the Claim that you have submitted. The "Missing Rejection
Code" happens at a stage prior to where they have access, so quoting the Claim ID or
Transaction ID generally results in their advice that it's a software issue. Asking them to
confirm the Provider Numbers and Location / Minor ID generally reveals the cause of the problem.
  • If either Provider Number is not connected as expected, then pursue the best course of action for the situation, and then resubmit the claim when resolved.
  • If you're advised that the Provider Number(s) are connected correctly and the error persists, please let us know and we can delve into the issue further for you.

If you require further guidance on how to reset a claim click here.

If you come across other error messages and you are not sure how to deal with it, please contact Support so we can assist.

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