Patient Claims quality checking processing 111-22090020
Expand allThis page contains information about the error status codes (including the non-error code), attachments and intranet links.
Status code categories
Table 1: this table lists the categories of status codes for patient claims quality checking.
Category | Displayed in QCS as… |
Error-free | OK |
Document status codes | ADM |
Processing status codes | PRO |
Referred for further attention | REF |
Error-free status code
Table 2: this table lists the error free status code for manual and online patient claims quality checking.
Error-free status code | Definition | Processing Tip |
001 | Error-free | Quality check did not detect errors |
Document error status codes
Table 3: this table lists the document error status codes for patient claims quality checking.
Note: the following processing tips apply to all channels unless otherwise stated.
Error status codes | Definition | Processing tip |
100 | Address change not notated, or the address section of the claim form not completed. | Claim form It is an error when the address section of the claim form is partially complete and there is no notation of a confirmed address. It is an error when an address change has not been notated. |
101 | Claim form not attached to supporting documentation or account not endorsed by claimant. | Claim form It is an error when:
Telephone claiming It is an error when the account/receipt for claims received via the telephone are not endorsed by the claimant and no contact was made by the Service Officer. Note: Access Point (MAAP) As there is no paperwork to check against any claims selected for quality checking, these are currently being entered 001 (error-free) on the QBBI screen. |
102 | Agent's authority section of claim form not completed in full. | It is an error when the Agent's Authority Section has not been fully completed and is not detected by the Service Officer. |
104 | S4B (3) item paid without the delegate's approval. | It is an error when a delegate's approval is not endorsed on the documentation for payment of an item under the S4B (3) rule and it is not detected by Service Officer. |
105 | Patient's/Claimant's Medicare card number cannot be uniquely identified from details supplied. | It is an error when the source documents do not have sufficient information to uniquely identify the patient's or claimant's Medicare card number, and no contact was made by Service Officer. |
106 | No evidence of confirmation of service or claim details recorded. | It is an error when the Service Officer failed to record details of confirmation to support action taken. |
110 | Claimant's signature omitted or mismatched to claimant details. | It is an error when:
Note: it is not an error if the claimant details have been verified and there is a VG4 form to support action taken. Claimants can use any type of symbol as their signature, for example, X. Claims should only be returned where there is a difference in names. |
111 | Inappropriate/insufficient documentation to support payment. | It is an error when:
|
118 | Statement of Benefit not attached to supporting documentation. | It is an error when a:
|
199 | More than four document errors. | When four document errors are detected, key all four error codes. When more than four document errors are detected, key the first three error codes followed by error code 199. When more than four errors are made and there is a combination of processing and document errors, use 299 as the fourth error code. |
Processing error status codes
Table 4: this table lists the processing error status codes for patient claims quality checking.
Processing error status codes (continued)
Table 5: this table lists the processing error status codes for patient claims quality checking.
The Quality Control System (QCS) for Medicare
For HSDD staff - QBBI quality checking error free template
For HSDD staff - QBBI quality checking error template
Face to face staff