CLAIMING.COM.AU

Reponse codes for Verification requests

Medicare Status Code

Code Explanation
0 Patient Eligible for Medicare
8003 Patient is currently ineligible for Medicare. This status can be confirmed for today only.
8005 The individual has been matched using the submitted data however differences were identified. Please check the information returned and update your records.
8009 The name supplied for this individual differs from that held by Medicare. This individual only has one name. Please check the name and update your records.
9626 The patient is or was covered under the Reciprocal Health Care Agreement.
9633 A new Medicare card has been issued. Please update your records and ask the patient to use the new card number for any future claims.
9649 Patient Eligibility Cannot be Determined.
9650 Patient data supplied failed validation checks a HIC central site.
9675 Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected.

Fund Status Code

Code Explanation
0 Patient Eligible
8007 Membership matched. Please ask patient to contact the fund.
8008 Membership matched but provider must contact the fund.
9369 The patient fund membership number must be supplied.
9370 The fund brand Id must be supplied.
9662 Provider must contact Fund.
9663 Check Fund and Membership Card details.
9664 Check Patient details. If correct, check Fund and Membership Card. If correct, the name known to fund may differ from Medicare or Patient Unique Identifier has not been supplied (if applicable to fund).
9665 Cannot uniquely identify Patient from information supplied.
9666 Patient must contact fund.
9667 Check Membership details. If correct, patient must contact fund.
9668 Medical claims are not covered for this patient. Patient must contact fund.
9669 Membership details matched however claims for the patient cannot be submitted using this channel at this time. Patient to contact fund.
9674 Fund patient validation not undertaken as the Medicare validation was unsuccessful.

Concession Status Codes

Code Explanation
0 Patient Eligible for Concession
9650 Patient data supplied failed validation checks a HIC central site.
9685 A concession entitlement has not been found for this patient.

DVA Status Codes

Code Explanation
0 The patient details have been matched against the DVA record
8012 Patient details have a POTENTIAL match with DVA Data. Updated details have been supplied. Please check the information returned with the patient, and if correct, update your records.
8009 The name supplied for this individual differs from that held by Medicare. This individual only has one name. Please check the name and update your records.
9650 Patient data supplied failed validation checks a HIC central site.
9665 Cannot uniquely identify Patient from information supplied.