To view the Medicare response code for a claim that was rejected you can select the "Invoices" tab, and select the invoice.

The response code will be next to the item code at the bottom of the invoice.


You can see the full list of Medicare reason codes below:
Medicare 3 digit reason codes
Medicare 4 digit reason codes

Note: these links will download a .csv file that can be opened in Excel.


Medicare patient claims


9601 - The claim needs to be referred to a Medicare Customer Support Officer for further assessment

9605/9606/9633 - Another Medicare Card may have been issues, or the details you entered do not match

9607 - This item is only claimable via bulk bill

9624 - A subsequent consultation has been keyed and the date of service is after the referral expiry

9625 - Claimant address needs to be updated with Medicare

9628 - Referral or request required

9630 - Please check the request or referral details

9632 - Duplicate of service already paid. If not duplicate resubmit with appropriate indication

9635 - Check Servicing Provider. May not be able to provide the service for this item at date of service

9638 - Claimant details required. Patient or quoted claimant is a minor

9641 - A restrictive condition exists

9698 - Service is possible aftercare, check the account and resubmit with a valid indicator if not normal aftercare


Medicare bulk billed claims


137 - Details of requesting provider not shown on account/receipt

160 - Maximum number of services for this item already paid

162 - Benefit has been previously paid for this service

250 - Explanation/voucher will be forwarded separately

252 - Service possibly aftercare

255 - Benefit assigned has been increased

267- Service not payable - associated service not present

378 - Provider cannot refer/request service at date of request

606 - Referring provider number not open at date of referral

609 - Service cancelled at providers request

642 - Benefit paid for derived and other item claimed



Four digit response codes

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9601 response code

"Claim successfully transmitted and pended for further assessment by a Customer Support Officer. Claimant will be advised of outcome by mail"

This claim wasn't able to be processed automatically through Medicare Online.
The Medicare claim will be manually processing this claim.
If you'd like to follow up on the claim it's best to speak to Medicare's eBusiness directly on 1800 700 199.

9605 9606 9633 response codes

"Another Medicare Card may have been issued to the patient or the details you entered do not match those held by Medicare"
These response errors show the patient's Medicare card details are expired, and a new card has been issued.
You'll need to get in touch with the patient to ask for their updated card details.
You can edit their patient record to reflect these new details and submit this claim again.

9607 response code

"This item is only claimable via Bulk Bill"

This claim is not able to be processed as a patient claim as the item code is only to be bulk billed.
You can submit this claim again as a bulk billed claim.


9624 response code

"A subsequent consultation has been keyed and the date of service is after the referral expiry date"

This error codes means this claim is for a patient who has attended their 2nd or subsequent consultation and the date of that consultation was after the referral has expired for that patient.
You can see more details about referral periods here.

9625

"Claimant address needs to be updated with Medicare, Issue account/receipt for the claimant to submit via an alternative Medicare claiming channel"

Medicare needs the patient to update their address recorded with Medicare before any claims can be processed successfully.
The patient can update their address with Medicare via their Medicare online account in MyGov, the Express Plus Medicare app or by phone.
For more details you can see this Medicare guide.

Once the patient updates their details with Medicare this claim can be submitted again.
If the payment is already taken you can follow these steps to submit the Medicare claim.

9628 response code

"Referral or request required"

A referral or request is required for this claim.
If the referral details were not submitted for this claim you'll need to submit this claim again with the referral details added.
To see how to add referral details to a Medicare claim you can click here.

9630 response code

"Please check the request or referral details"

This error means you'll need to check referral or request for this claim.
If the referral details were incorrect, you can submit this claim again with the correct date.


9632 response code

"Duplicate of service already paid. If not duplicate resubmit with appropriate indication"

This error means the claim has been sent to Medicare multiple times and was rejected as the first claim was processed and paid.
If this claim is a new claim, confirm you've added the correct details and submit the claim again.
If the claim continues to be rejected it's best to speak to Medicare on 1800 700 199.

9635 response code

"Check Servicing Provider. May not be able to provide the service for this item at date of service"

For this item code it's best to double check the provider details, as they might not be able to provide the service for this item at date of service.
If in double it's best to speak to Medicare's eBusiness team about this claim on 1800 700 199.

9638 response code

"Claimant details required. Patient or quoted claimant is a minor"

This response code means the patient is a minor. For a claim where the patient is a minor you'll need to enter their parent or guardian's details for them to receive the benefit.
You can see how to enter these details to a Medicare claim here.
This claim can be submitted again with the claimants details entered in the claim.

9641 response code

"A restrictive condition exists"

This error relates to a restrictive condition between the patient and Medicare.
If all the patient and claim details are correct the patient will need to claim their benefit back from Medicare directly.
You can download the Medicare statement at the bottom of a claim and send this to the patient.
They'll be able to use these details to claim back their benefit either through Medicare online (accessed in myGov) or through the Express Plus Medicare app.
More details regarding the patient claiming directly with Medicare can be found here.

9698 response code

"Service is possible aftercare, check the account and resubmit with a valid indicator if not normal aftercare"

This claim may have item codes for post-operative care and treatment after an operation.
These item codes need to include details such as the aftercare period or GP attendances.
You can see how to include aftercare details in Medipass here.

If this transaction is not related to normal aftercare you may be able to re-submit the payment request.

To be 'not normal aftercare', the treatment would need to be an unrelated condition or

complications arising from the operation

To resubmit the payment request in these cases using Medipass, you will need to use the "Aftercare Override" indicator in the advanced Options.

You can see how to override the aftercare details in Medipass here.

Three digit response codes

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137 response code

"Details of requesting provider not shown on account/receipt"

This response code means the referral details weren't added to the claim.
You can submit this claim again and enter the referral details.
To see how to add referral details in Medipass you can click here.

160 response code

"Maximum number of services for this item already paid"

This error is most likely due to the patient exceeding their allocated sessions of their care plan.

For more details about chronic disease management plans, you can click here.

We recommend speaking to your patient, and let them know they've exceeded their allocated Medicare sessions for this calendar year. This means any additional sessions this year won't be eligible for Medicare claiming.

For the patient's next appointment they can pay fully out of pocket, or with their private health insurance.

You can also provide the written report to the referring GP, and discuss with them whether additional sessions are required.

162 response code

"Benefit has been previously paid for this service"

This error means the claim has been sent to Medicare multiple times and was rejected as the first claim was processed and paid.

250 response code

"Explanation/voucher will be forwarded separately"

An explanation or voucher will be forwarded to the business separately.

252 response code

"Service possibly aftercare"

This claim may have item codes for post-operative care and treatment after an operation.
These item codes need to include details such as the aftercare period or GP attendances.
You can see how to include aftercare details in Medipass here.

If this transaction is not related to normal aftercare you may be able to re-submit the payment request.

To be 'not normal aftercare', the treatment would need to be an unrelated condition or

complications arising from the operation

To resubmit the payment request in these cases using Medipass, you will need to use the "Aftercare Override" indicator in the advanced Options.

You can see how to override the aftercare details in Medipass here.

255 response code

"Benefit assigned has been increased"

If an item code was submitted below the Medicare scheduled benefit Medicare will automatically adjust the benefit paid to the business to reflect the current benefit fee.

267 response code

"Service not payable - associated service not present"
Medicare have not paid this service. This can be due to the associated service not being included on this claim.
You can submit this invoice again and add the associated item code.

378 response code

"Provider cannot refer/request service at date of request"

Provider cannot refer or request service at date of request.

606 response code

"Referring provider number not open at date of referral"

This error often means the referral provider number was not registered with Medicare when this referral was issued.
It's best to speak with the referring doctor to confirm the provider number, or the correct provider number to use for this referral.

You can then submit this claim again with the correct provider number for the referral.

609 response code

"Service cancelled at providers request"

This error shows that the claim has been rejected by Medicare after the provider has requested this.

642 response code

"Benefit paid for derived and other item claimed"

Benefit paid for derived and other item claimed.

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