on this page
A return code includes a message about why your claim was rejected or how it was assessed. This information can be:
- to identify any claiming errors
- to make corrections
- for your reference
- to re-submit claims.
Medicare return codes - 4 digit codes
We send 4 digit return codes when errors happen. The codes help you take action to claim.
Any messages returned relate to 1 of the following categories.
Function related - 1xxx or 2xxx
Functional errors are either:
- when a condition, that’s not a data validation matter or assessing condition, is found by your digital claiming software, or
- by environmental factors or coding errors within your software, including:
- errors in the form
- sequencing of functions calls including an attempt to use a non-existent client adaptor session with the incorrect session ID.
Transmission - 30xx
Transmission errors as a result of environmental factors or coding errors within the software, include:
- communication errors to a remote server
- a remote server isn't available.
Information messages - 52xx and 8xxx
The code for information messages are returned in the error code field.
Data - 70xx and 90xx
Data errors when you've:
- provided a service date, set in the future
- not given a postcode with a claimant address.
When a report is available, you'll see one of these return codes:
- 9501 - a submission response report is available
- 9502 - multiple reports are included in the response.
Other errors - 1999
The value will be 1999 when an error happens and there’s no return code.
Integrating return codes for Medicare Online and ECLIPSE
When you integrate the client adaptor application into your software:
- some return codes are only available when these interfaces are combined
- if successful, the action you should take when an error code is returned will depend on what’s appropriate for your client system
- some errors will be resolved.
You can upload the Medicare 4 digit return codes to your client adaptor application. You can do this by downloading the Medicare 4 digit return codes in a comma-separated values (CSV) format.
Open the CSV file as a variable width record in numeric and text where:
- numeric is the reason code number
- text is a short description.
This file format doesn't include column headings.
You can then upload the Medicare 4 digit return codes to your client adaptor application.
You can’t upload the Medicare 4 digit return codes if you have web services software.
Phone the eBusiness Service Centre to find out more about these codes.
Medicare reason codes - 3 digit codes
Medicare reason codes are 3 digit codes used in processing reports and in the Medicare statement of benefits. These codes provide information about how a claim was assessed.
We may reject a claim or give more information about:
- a Medicare statement of benefits where an ‘@’ symbol on a claim was changed to match the current card issue number
- the use of an incorrect Medicare Benefits Schedule (MBS) item
- the patient getting the maximum allowable benefits for an MBS item
- issues with eligibility of patients or health professionals
- a benefit assessed with the associated MBS item on the statement
- the need for extra details to assess the claim.
Downloading 3 digit reason codes into your programs
You can download the Medicare 3 digit reason codes in a comma-separated values (CSV) format into your programs.
Open the CSV file as a variable width record in numeric and text where:
- numeric is the reason code number
- text is a short description.
This file format doesn't include column headings.
Phone Medicare provider enquiries to find out more about these codes.
DVA and PBS reason codes
Other Medicare reason codes include: