Education guide - Medicare Online and ECLIPSE data elements

Only use this field when you need more information to support the claim for assessment. The field limit is 50 characters for Medicare claims. The limit for DVA claims is 100.

Check the table below for text field abbreviations. You can use the abbreviations if you’re running out of space.

Number of patients seen

This field indicates the number of patients a health professional has seen at a location. It includes patient visits to homes, hospitals, institutions or nursing homes. Use this for group attendance items, such as counselling.

You must supply this when you claim. If you don’t, you’ll get overpaid.

This field indicates whether multiple services performed on the same day by the same health professional are separate services.

Set values:

• Y - not a duplicate service
  • either set time of service or include information in the service text field to support your payment
• N - duplicate service.

• S - standard referral period is
  • 12 months for GPs
  • 3 months for specialists
• N - non-standard period
  • enter the time the referral is valid for in months - must be between 1 and 98
• I - indefinite period.

This code indicates why referral services were provided without a referral from another health professional.

The indicators or codes are:

• H - Hospital
  • H is an in-hospital referral - for a privately admitted patient, generated in a hospital for a service in that hospital
  • for these claim types, referred within and facility ID data will populate automatically. You don’t have to enter these details in the service text
  • for other online claim types you need to enter either the hospital provider number (facility ID) or the hospital name in the service text

• L - Lost
  • L is a lost, stolen or destroyed referral. This applies to initial attendance items only and a referral is needed for subsequent attendances
• E - Emergency
  • E is a referral in an emergency situation. This applies to initial attendance items only, and a referral is needed for subsequent attendances
• N - Not required (Non-referred)
• R - Remote Exemption (DVA only).

Claim types for ECLIPSE in-patient medical claims (IMC) are:

• Agreements (AG)
• Schemes (SC)
• billing agent, Medicare and private health insurer (MB)
• billing agent, Medicare only (MO).

Self-deemed codes indicate that a health professional has provided a service that would usually be a referred service without a referral or request.

There are 3 self-deemed codes:

• SD - self-deemed
  • SD is a service provided by a consultant physician or specialist as an additional service to a valid request.
• SS - substituted service
  • SS is a service provided that has replaced the original service requested
• N - not self-deemed.

Submit all self-deemed diagnostic imaging services without additional service text. If you need to add more text, begin the service text field with 'Self-deemed'.

Use this field for radiation oncology services - Medicare Benefits Schedule Group T2 services.

It’s used to provide the number of fields of treatment delivered to the treatment site or the quantity of time blocks for services.

If you don’t supply this information when claiming, you may get underpaid.