Medicare Customer quality checking in Quality and Support Tool (QST) 111-22042744
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See Service Delivery Quality and Evaluation for a link to the Enterprise Quality Framework.
Medicare Safety Net Error codes
Table 1
| Error codes Classification | Definition |
| SN0 Error-Free | No errors |
| SN1 Critical | Customer cannot be uniquely identified |
| SN2 Critical | Bank details incorrectly added for other members |
| SN3 Critical | Bank Details not updated for the customer |
| SN4 Critical | Bank details not updated for other members |
| SN5 Critical | Form not signed |
| SN6 Critical | Incorrect Date of registration used |
| SN7 Critical | Incorrect or insufficient information on form |
| SN8 Critical | Incorrect year confirmed |
| SN9 Critical | Member incorrectly removed from previous family safety net |
| SN10 Critical | Members incorrectly added to family Safety Net |
| SN11 Critical | Members incorrectly removed from family Safety Net |
| SN12 Critical | Members not added to family Safety Net |
| SN13 Critical | Members not removed from family Safety Net |
| SN14 Non-Critical | Address not updated |
| SN15 Non-Critical | Incorrect member status used |
| SN16 Non-Critical | Incorrect Source entered |
| SN17 Non-Critical | Customer details not updated |
| SN20 Critical | Service has not been substantiated |
| SN21 Critical | Service substantiated without supporting documents |
| SN22 Critical | Substantiated amount incorrect |
| SN23 Critical | Incorrectly ended a family Safety Net Registration |
| SN24 Non-Critical | Confirmation details do not match comments |
| SN25 Non-Critical | Comments field not update or inappropriate |
| SN26 Non-Critical | Incorrect member selected for confirmation |
| SN27 Critical | Incorrect claimant selected for substantiation for rebate |
| SN28 Critical | Safety Net Not confirmed/actioned |
| SN29 Critical | Incorrect date used for safety net confirmation |
| 319 Critical | Medicare Safety Net calculations completed incorrectly and/or evidence of manual calculations not uploaded in PaNDA |
Claims and Assessing - Patient Claims Error codes
Table 2
| Error codes Classification | Definition |
| 001 | Error-free |
| 100 Critical | Address change not notated or the address section of the claim form not completed |
| 101 Critical | Claim form not attached to supporting documents or account not endorsed by claimant |
| 102 Critical | Agent's authority section of claim form not completed in full |
| 104 Critical | S4B(3) item paid without the delegate's approval |
| 105 Critical | Patients/Claimants Medicare card number cannot be uniquely identified from details supplied |
| 106 Critical | No evidence of confirmation of service or claim details recorded |
| 110 Critical | Claimant's signature omitted or mismatched to claimant details |
| 111 Critical | Inappropriate/insufficient documents to support payment |
| 118 Critical | Statement of Benefit not attached to supporting documents |
| 199 Critical | More than four document errors |
| 200 Critical | Patient keyed or selected incorrectly |
| 201 Critical | Item keyed incorrectly |
| 202 Critical | Date of service keyed incorrectly |
| 204 Critical | Charge keyed incorrectly |
| 205 Critical | Item paid incorrectly as outpatient |
| 206 Critical | Incorrect processing indicator (PI) keyed |
| 207 Critical | Reason code not keyed, keyed incorrectly or keyed when not required |
| 208 Critical | Medicare card number for claimant or patient keyed incorrectly or consumer ID for claimant keyed incorrectly |
| 209 Critical | LSPN keyed incorrectly |
| 210 Critical | Service provider keyed incorrectly |
| 211 Critical | Notional charge not applied or applied incorrectly |
| 212 Critical | Text transmitted not actioned appropriately |
| 213 Critical | Telephone claim paid incorrectly |
| 214 Critical | Items not keyed |
| 215 Critical | SCP keyed incorrectly |
| 216 Critical | Radiation oncology fields not keyed or keyed incorrectly |
| 217 Critical | Over 2 year old or over 5 year old claim paid incorrectly |
| 218 Critical | PAYP line not keyed or keyed incorrectly |
| 220 Critical | Miscellaneous line keyed |
| 221 Critical | Incorrect or inappropriate manual calculation of schedule fee |
| 224 Critical | Provider location keyed or selected incorrectly |
| 228 Critical | Address not changed or changed incorrectly |
| 229 Critical | Restrictive item paid incorrectly |
| 232 Critical | Cancel and reissue cheque issue |
| 233 Critical | EFT paid inappropriately |
| 235 Critical | Cheque paid to provider on paid account |
| 238 Critical | Item paid incorrectly as inpatient |
| 239 Critical | Referral details (SR and AH) keyed incorrectly |
| 240 Critical | Diagnostic request details (DI) keyed incorrectly |
| 241 Critical | Pathology request details (PA) keyed incorrectly |
| 242 Non-critical | ACRF details keyed incorrectly |
| 245 Critical | Claimant's name or reference number keyed or selected incorrectly |
| 247 Critical | Service verified inappropriately or has not been verified |
| 248 Critical | Verified amount incorrect |
| 249 Critical | Additional item lines keyed without justification |
| 250 Critical | Item lines rejected in error |
| 253 Critical | EFT details keyed or stored incorrectly |
| 310 Critical | Two way claim form not transmitted/transmitted incorrectly |
| 311 Critical | Work item not actioned completely |
| 312 Critical | AODR not actioned in patient claim form |
| 313 Non-critical | Comments not keyed when appropriate or completed incorrectly |
| 314 Critical | Claim adjustment completed incorrectly |
| 315 Critical | Letter created contains errors which impacts on privacy implications |
| 316 Non-critical | Letter created contains minor errors which does not impact on customer privacy |
| 317 Critical | Manual Electronic Funds Transfer (EFT) payment request not completed or was completed incorrectly |
| 318 Critical | Debt Advise Notice (DAN) not created for overpayment or DAN contains errors |
| 319 Critical | Medicare Safety Net calculations completed incorrectly and/or evidence of manual calculations not uploaded in PaNDA |
| PC03 Critical | Incorrect letter/advice sent to claimant or provider or patient |
| PC08 Critical | Business/Third party claim processed incorrectly |
| PC09 Non-critical | MOA - Documents should not be associated together in PaNDA |
| PC10 Critical | MOA - Service details should have been amended as a minor discrepancy |
| PC11 Critical | Letter not issued to the customer when appropriate |
| PC13 Non-critical | Customer details not recorded in PaNDA |
Claims and Assessing - Patient Claims Payments Error codes
Table 3
| Error codes Classification | Definition |
| E001 | Error-free |
| E06 Critical | Address details omitted |
| E11 Critical | Name/s incomplete or omitted |
| E16 Critical | Signature omitted or incomplete |
| E55 Non-Critical | Personal contact details not keyed or keyed incorrectly |
| E56 Critical | EFT banking details keyed incorrectly |
| CA1 Critical | Storing bank details for customers under 14 years of age |
| CA2 Critical | Selecting incorrect Notification Source on CDMS (should always be EFT Details Collection Form) |
| CA3 Critical | Not updating customers bank details who have filled out consent to nominate bank account (Q7) |
| CA4 Critical | Form signed by verified POA (already in CDMS) and returned in error |
| CA5 Critical | Form was signed by someone other than the customer |
| CA6 Critical | Customer has not signed the form and banking details have been updated |
| CA7 Critical | Medicare Card Number does not match the customer's details and application processed |
| CA8 Critical | Bank details stored/lodged against the incorrect customer |
| CA9 Critical | Form was not signed by customer and comments not left advising customer was contacted & the declaration read to the customer |
| CA10 Non-Critical | Title not updated or updated incorrectly |
| CA11 Critical | Mailing address not updated or incorrectly updated or only updated in personal |
Medicare Eligibility Error codes
Table 4
| Error codes Classification | Definition |
| 001 | Error-Free |
| E06 Critical | Address details omitted |
| E08 Critical | Insufficient, incomplete or no documentation/comments to support Medicare Safety Net confirmation |
| E10 Critical | Reason for copy or transfer application omitted |
| E11 Critical | Name/s incomplete or omitted |
| E12 Critical | Gender omitted |
| E13 Critical | Insufficient documentation to support the enrolment for child in state/foster care |
| E16 Critical | Signature/declaration omitted or incomplete |
| E19 Critical | Insufficient, inappropriate or no documentation to support enrolment Note: this includes DME (Digital Medicare Enrolment) and Digital Medicare Extension (DMX) where insufficient, or inappropriate documents have been accepted or VEVO has not been completed in MEE portal |
| E20 Critical | Insufficient or incorrect identification to support the enrolment amendment |
| E22 Critical | DIAC/Applicant for permanent residency Insufficient, inappropriate or no documentation to support the enrolment Note: this includes DME and DMX applications where insufficient, or inappropriate documents have been accepted or VEVO has not been completed in MEE portal |
| E23 Critical | Returning residents/citizens and New Zealand citizens residing permanently in Australia Insufficient, inappropriate or no documentation to support the enrolment Note: this includes DME applications where insufficient, or inappropriate documents have been accepted or VEVO has not been completed in MEE portal |
| E24 Critical | New enrolment Reciprocal Health Care Agreement Insufficient, inappropriate or no documentation to support the enrolment |
| E39 Critical | More than four document errors |
| E40 Critical | Incorrect Medicare card number or duplicate record created |
| E41 Critical | Group contact first name or family name incorrect or not changed |
| E42 Critical | Long name details incorrect/not required |
| E43 Critical | Address details keyed incorrectly or not updated when appropriate |
| E44 Non-Critical | Comments field not completed when appropriate or completed inappropriately |
| E45 Critical | Ineligible customer's enrolled |
| E46 Critical | Entitlement type incorrect or not changed when appropriate |
| E47 Critical | Country of relevance/Reciprocal Health Care Agreement (RHCA) country selected incorrectly |
| E48 Critical | Power of attorney (POA) details incorrect or not completed when appropriate |
| E49 Critical | Entitlement start date incorrect or not changed when appropriate |
| E50 Critical | Entitlement end date or entitlement end reason incorrect or not changed when appropriate |
| E51 Critical | Return mail indicator selected incorrectly, not selected or type of return mail incorrect |
| E52 Critical | Medicare Copy/Transfer not actioned or actioned incorrectly |
| E53 Critical | Replacement card not issued or issued incorrectly |
| E54 Non-Critical | Title and/or suffix selected incorrectly |
| E55 Non-Critical | Personal contact details not keyed or keyed incorrectly |
| E56 Critical | EFT banking details not keyed or keyed incorrectly |
| E57 Critical | Name not keyed or keyed incorrectly Note: this includes DME and DMX applications where names have not been amended as per the supporting documentation in the MEE portal |
| E60 Critical | Gender selected incorrectly or not changed when appropriate Note: this includes DME and DMX applications where gender has not been amended as per the supporting documentation in the MEE portal |
| E61 Critical | Date of birth keyed incorrectly Note: this includes DME and DMX applications where date of birth has not been amended as per the supporting documentation in the MEE portal |
| E62 Critical | Date of death or notification source incorrect |
| E63 Non-Critical | Aboriginal/Torres Strait/South Sea Islander status selected incorrectly or not updated |
| E64 Critical | Eligibility and/or residency documents keyed/selected incorrectly or not entered |
| E67 Critical | Medicare Safety Net registration member type keyed incorrectly or not updated |
| E68 Critical | Member omitted, added in error, registered with an incorrect date of registration or not removed from a family Safety Net registration when appropriate |
| E69 Critical | Family confirmed incorrectly |
| E70 Critical | Customer registered incorrectly without consent |
| E71 Critical | Work item not actioned completely |
| E72 Critical | Sensitive indicators not selected/selected incorrectly |
| E73 Critical | LHC request not actioned when appropriate |
| E74 Critical | DVS not actioned/comments keyed when appropriate |
| E75 Critical | Online enrolment not actioned/closed/actioned incorrectly Note: this includes DME and DMX applications rejected incorrectly or DME/DMX ID not recorded in CDMS |
| E76 Critical | Contact details recorded or not removed for children under 15 years |
| E89 Critical | More than four processing errors |
| ENR4 Critical | My Health Record request not actioned or actioned incorrectly. This includes DME and DMX applications where the MHR error has occurred Note: the MHR error email template must be completed and sent to the My Health Record Support team for action |
| ENR6 Critical | Medicare card stopped incorrectly or without comments |
| ENR7 Critical | Duplicate Consumer ID created |
| ENR8 Critical | Using the incorrect Letter template for rejected /approved or more information needed |
| ENR9 Critical | Rejection letter addressed to the wrong person |
| ENR10 Critical | Rejected enrolment has incorrect information |
| ENR11 Critical | Rejected enrolment has incorrect attachments |
| ENR12 Non-Critical | Work classification incorrect |
| ENR13 Non-Critical | Error on Naming Convention |
| ENR14 Non-Critical | Error in Comments |
| ENR15 Critical | Documents missing |
| ENR16 Non-Critical | Files not merged in PaNDA |
| ENR17 Critical | Incorrect Merge on Files in PaNDA |
| ENR18 Critical | CDMS action not completed i.e. accept/reject digital enrolment |
| ENR19 Critical | Newborn not added to Safety Net |
| ENR20 Non-Critical | Document reference text details incorrect/incomplete |
| ENR21 Critical | Newborn not added to additional Medicare Card |
| ENR22 Critical | Comments not added to confirm consent obtained to add newborn to additional cardholders card |
| ENR23 Critical | Newborn enrolled in error |
| AR1 Critical | Authorised Representative (AR)-Form completed incorrectly |
| AR2 Critical | AR-Name keyed incorrectly |
| AR3 Critical | AR-Original documents not photocopied by Service Officer |
| AR4 Critical | AR-Authority to Act on a Persons behalf Application form was not used for an authorised representative |
| AR5 Critical | AR-Declaration not signed by the requesting customer/authorised representative |
| AR6 Critical | AR-Statutory declaration must be completed by the person allocated the authority |
| AR7 Critical | AR-POA field - Authorised Representative must be selected |
| AR8 Non-Critical | AR-Relationship to the Customer must be stated on the form and entered into POA text |
| AR9 Critical | AR-Incorrect if the authorised representative is a paid carer from an organisation institution or community health service |
| AR10 Critical | AR-Identity documents not verified in Medicare Document Verification Service (DVS) Portal |
| AR11 Critical | AR-Incorrect evidence of a similar arrangement accepted |
| AR12 Critical | AR-ID has not been supplied |
| AR13 Non-Critical | AR-Incorrect start date entered |
| AR14 Critical | AR-Updated incorrect customer record |
| AR15 Critical | AR-Using the incorrect Letter template for rejected /approved or more information needed |
| AR16 Critical | AR-Letter addressed to the wrong person |
| AR17 Non-Critical | AR-Rejected application has incorrect information |
| AR18 Critical | AR-Rejected application has incorrect attachments |
| AR19 Non-Critical | AR-Incorrect start date entered |
| AR20 Non-Critical | AR-Incorrect reference used |
| AR21 Non-Critical | AR-Work classification incorrect |
| AR22 Non-Critical | AR-Error on Naming Convention |
| AR23 Non-Critical | AR-Error on Comments |
| AR24 Non-Critical | AR-Documents missing |
| AR25 Non-Critical | AR-Files not merged |
| AR26 Critical | AR-Incorrect Merge on Files |