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Table of common data elements
The table of data elements outlines:
- common data elements or fields and their descriptions and use
- the type of claims where you should fill in the field.
If you’re using the integrated solution, the fields where you enter the data on your EFTPOS terminal or your practice software management software may have different names or be in different places as software packages may vary.
For more information on data elements or fields and how to use them to lodge claims refer to your:
- software vendor
- financial institution
- software help guide.
Read more about vendors offering Medicare online claiming and Simplified Billing and ECLIPSE.
Data element or field | Description and use | Health professional claim type where you can use the field or data element | |||
---|---|---|---|---|---|
GP | Specialist | Diagnostic | Pathology | ||
Service type code |
Health professionals have to enter information in a claim to distinguish which type of service they’re submitting. Use different values depending on the type of service you’re claiming:
|
Yes | Yes | Yes | Yes |
Item override code |
Sometimes health professionals have to give more information in a claim so that we can assess the service. The item override code lets health professionals submit information for specific situations. It uses a 2-character indicator so that we correctly assess the service and pay the right amount. 2-character values include:
|
Yes | Yes | Yes | Yes |
Restrictive override code |
Sometimes health professionals have to provide more information in a claim so that we can assess the service. The restrictive override code lets health professional submit information for specific situations. It uses a 2-character indicator so that we correctly assess the service and pay the right amount. 2-character values include:
|
Yes | Yes | Yes | No |
Patient contribution amount |
The patient contribution amount is for when a claimant has made a part payment contribution towards the account. It’s only required if the account paid indicator is set to N. It shows values in cents i.e. 99999 = $9999.99. |
Yes | Yes | Yes | No |
LSPN number |
Only use a Location Specific Practice Number (LSPN) with:
This field is mandatory if these services occur. For example, if a health professional is performing diagnostic imaging services in a remote location they should include the LSPN when lodging the claim. An LSPN is 6 numbers. |
Yes | Yes | Yes | No |
Referral issue date |
The referral issue date is the date that the referring provider issued or wrote the referral. It must be in the format of DDMMYY. |
No | Yes | No | No |
Referral period type code |
The referral period type code shows how long referrals are valid for:
|
No | Yes | No | No |
Referral override type code |
The referral override type code is for when a health professional is lodging a claim and they need to indicate why they provided referral services without referral from another health professional. The values to choose from are:
|
No | Yes | No | No |
Request issue date |
The request issue date is the date the requesting provider issues or wrote the request. It must be in the format of DDMMYYY. |
No | No | Yes | Yes |
Request type code |
Health professionals have to enter information in a claim to distinguish which type of service they’re requesting. Some values they can use to request are: P = Pathology D = Diagnostic. |
No | No | Yes | Yes |
Request override type code |
The request override type code is for when a health professional is lodging a claim and they need to indicate why they provided referral services without referral from another health professional. The values to choose from are:
|
No | No | Yes | Yes |
Self-deemed code |
Self-deemed (SD) is an optional element for diagnostic and pathology claims. When the SD value is present, you can’t set request details.
|
No | No | Yes | Yes |
SCPId number |
The Specimen Collection Point (SCPId) identifies the site where the pathology specimen was collected. Note: This field is only available in bulk billing. |
No | No | No | Yes |
More information
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