Education guide - Medicare Easyclaim data elements

Explanations about common data elements or fields in Medicare Easyclaim that you might need to fill out. Filling them out correctly makes claims quicker.

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:

  • O = General practitioner
  • S = Specialist
  • D = Diagnostic
  • P = Pathology.
 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:

  • AO = Not normal aftercare
  • AP = Not duplicate service (am/pm).
 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:

  • SP = Separate sites
  • NR = Not related (care plans)
  • NC = Not for comparison.
 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:

  • services listed in the Diagnostic Imaging Services Table (DIST)
  • Group T2 - Radiation Oncology services in the General Medical Services Table (GMST).

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:

  • S = Standard - referral period is 12 months for GPs and 3 months for specialists
  • I = Indefinite period.
 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:

  • L = Lost - a lost, stolen or destroyed referral, only applies to initial attendance items - the health professional should obtain a referral for subsequent attendances
  • E = Emergency - referrals in an emergency applies to initial attendance items - the health professional should obtain a referral for subsequent attendances
  • N = Not required (Non-referred).
 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:

  • L = Lost - a lost, stolen or destroyed referral applies only to initial attendance items - the health professional should obtain a referral for subsequent attendances
  • E = Emergency - a referral in an emergency applies to initial attendance items - the health professional should obtain a referral for subsequent attendances.
 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.

  1. SD - self-deemed is a service provided by a consultant physician or specialist as an additional service to a valid request
  2. SS - substituted service is a service provided that has replaced the original service requested
  3. N - not self-deemed.
 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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Page last updated: 10 December 2021