Medicare eligibility quality checking processing 111-22090030

Error-free status code

Definition

Processing tip

001

Error-free

Quality check did not detect errors.

Error status codes

Definition

Processing tip

E06

Address details omitted.

Use this error code when the address details were omitted from an enrolment form (or written correspondence) and there is no verification present.

E10

Reason for copy or transfer application omitted.

Use this error code when the option for a copy or transfer has not been notated/tickbox on the form and there are no recorded comments in PaNDA/CDMS about customer contact.

E11

Name/s incomplete or omitted.

Use this error code when the form was incomplete, had no verification present or the following details were omitted, the customer's:

• first name
• surname
• second name (if applicable)

This error does not apply to the name stated in the declaration.

E12

Gender omitted.

Use this error code when a customer's gender has been omitted from the Medicare Enrolment form (MS004) and no verification is present.

E13

Insufficient documentation to support the enrolment for child in state/foster care.

Use this error code if inappropriate or insufficient documentation exists to support the enrolment for a child under 15 years of age in state/foster care.

E16

Signature/declaration omitted or incomplete.

Use this error code when an enrolment was not signed/declaration, not completed and has no verification present (if applicable).

Note: signatures may be required for all customers 14 years of age and over for EFT collection and all other forms 15 years of age or over.

E19

Insufficient, inappropriate or no documentation to support the enrolment.

Use this error code if the following is not in the batch or not uploaded in PaNDA to support the enrolment:

• enrolment form
• correspondence
• VEVO confirmation
• Documents not accepted and VEVO not completed in MEE portal

E20

Insufficient or incorrect identification to support the enrolment amendment.

Use this error code when insufficient or no copies of required identification exist to support the enrolment amendment.

E22

DIAC/Applicant for permanent residency.

Insufficient, inappropriate or no documentation to support the enrolment.

Use this error code when a customer has been enrolled and:

• a Medicare Enrolment form (MS004) has not been completed
• passports for all card members have not been sighted and notated on CDMS
• eligibility documentation has been sighted but not notated for all members on CDMS
• DIAC link is not selected for all members when present
• DIAC link for the incorrect customer is selected
• Documents not accepted and VEVO not completed in MEE portal

Note: this may need referral to the Compliance Operations area, Program Review Division.

E23

Returning residents/citizens and New Zealand citizens residing permanently in Australia.

Insufficient, inappropriate or no documentation to support the enrolment.

Use this error code when a customer has been enrolled and:

• a Medicare Enrolment form (MS004) has not been completed
• passports for all card members have not been sighted and notated for all members on CDMS
• documents have been sighted but not notated for all members on CDMS
• mandatory minimum residency document requirements have not been met
• statutory declaration incomplete

E24

New enrolment Reciprocal Health Care Agreement.

Insufficient, inappropriate or no documentation to support the enrolment.

Use this error code when a customer has been enrolled and:

• a Medicare Enrolment form (MS004) has not been completed
• passports for all card members have not been sighted and notated on CDMS
• additional Reciprocal Health Care Agreement (RHCA) support documents have not been sighted and notated on CDMS (where applicable)

E39

More than four document errors.

If 4 document errors are detected, key all 4 error codes in the status value available.

If more than 4 errors detected, key the first 3 errors with applicable code and key E39 as the fourth error.

When more than 4 errors are made and there is a combination of document and processing errors, use E89 as the fourth error.

Error status codes

Definition

Processing tip

E40

Incorrect Medicare card number or duplicate record created.

Use this error code when an enrolment has been processed under an incorrect card number.

It is an error if a duplicate pin/ consumer ID was created when completing an enrolment. If a customer record already exists in CDMS, it must be used to associate the Medicare enrolment.

E41

Group contact first name or family name incorrect or not changed.

Use this error code when the group contact:

• was keyed incorrectly
• selected contact does not match supporting documentation
• was not updated when group contact is:
• transferred to a new group/name change not actioned
• deceased

E42

Long name details incorrect/not required.

Use this error code when the:

• group member's fields:
• customer's name keyed incorrectly
  For example, key as much of the customer's name as possible
• Medicare long name fields:
• first and surname have not been completed in full
• second name has been keyed in full
• name not shortened in group as requested

It is an error to create a 'Long name record' when the name is not long, or long name process has not been completed.

Note:

• only one customer can be associated with this Medicare card
• for quality control purposes, it is one error if both sections of fields are in error:
• Group contact name, and
• Customer's long name

E43

Address details keyed incorrectly or not updated when appropriate.

Use this error code when the address was:

• keyed incorrectly
• not updated
• keyed in Personal inappropriately
• residential address recorded or not omitted for children under 15 years of age

E44

Note: non-critical error. This must not be recorded on QBBI, only on the online Error Explanation Sheet.

Comments field not completed when appropriate or completed inappropriately.

Use this error code when the comments:

• keyed are inappropriate or not related to the correct:
• customer
• section of CDMS, for example, Personal, Entitlement or Group
• were not keyed when appropriate

Note: see E73 for comments related to LHC letters.

E45

Ineligible customers enrolled.

Use this error code when a customer was enrolled and the supporting documentation indicates they are not eligible.

E46

Entitlement type incorrect or not changed when appropriate.

Use this error code when the entitlement type has:

• been selected incorrectly
• not been changed

E47

Country of relevance/Reciprocal Health Care Agreement (RHCA) country selected incorrectly.

Use this error code when the Country of Relevance/RHCA country selected does not match supporting documentation.

E48

Power of attorney (POA) details incorrect or not completed when appropriate.

Use this error code when the POA details have been:

• keyed incorrectly
• selected incorrectly
• completed with insufficient supporting documents

E49

Entitlement start date incorrect or not changed when appropriate.

Use this error code when the entitlement start date has:

• been keyed incorrectly
• not been changed

Note: it is not an error when the dates have been updated as per Department of Home Affairs link.

E50

Entitlement end date or entitlement end reason incorrect or not changed when appropriate.

Use this error code when the:

• entitlement end date has been keyed incorrectly
• entitlement end date has not been changed or removed
• entitlement end reason has been selected incorrectly

E51

Return mail indicator selected incorrectly, not selected or type of return mail incorrect.

Use this error code when the:

• return mail indicator was not recorded in Group or Personal
• return mail indicator selected incorrectly in Group or Personal
• type of return mail was selected incorrectly in Group or Personal
• return mail has been updated at Personal and not Group (where appropriate)

E52

Medicare Copy/Transfer not actioned or actioned incorrectly.

Use this error code when a customer has:

• been transferred to another group when a copy was requested
• been copied to another group when a transfer was requested
• not end-dated the association when appropriate
• their MS004/FA081 - Newborn not copied to partner's card when requested in Part C of MS004 or Q16 FA081

Note: when both parents are shown on a family card, children under 15 years of age should not be transferred without the authority of both parents. See Copy or transfer a person or child to another Medicare card.

E53

Replacement card not issued or issued incorrectly.

Use this error code when:

• a request for a replacement card was not actioned
• a replacement card was issued incorrectly
• the source of a replacement card request was selected incorrectly
• the reason for replacement card selected does not match supporting documentation

When processing a notification of death for a Medicare card with remaining members, do not issue a replacement card unless requested.

E54

Note: non-critical error. This must not be recorded on QBBI, only on the online Error Explanation Sheet.

Title and/or suffix selected incorrectly.

Use this error code when a title and/or suffix is incorrectly selected and has not been updated at Personal and/or Group.

E55

Note: non-critical error. This must not be recorded on QBBI, only on the online Error Explanation Sheet.

Personal contact details not keyed or keyed incorrectly.

Use this error code when a customer's contact details are not keyed or keyed incorrectly. This includes when the following do not match supporting documentation when legible:

• business phone number
• business comment
• home phone number
• home comment
• fax number
• fax comment
• mobile number
• mobile comment
• email address
• email comment

E56

EFT banking details keyed incorrectly.

Use this error code when a customer’s EFT details were:

• not keyed
• keyed incorrectly
• not updated
• not end dated
• recorded against the incorrect customer

E57

Name not keyed or keyed incorrectly.

Use this error code when a customer’s name or only name has:

• been keyed incorrectly
• not been keyed
• not been keyed in full when appropriate
• not been updated at personal or group level when appropriate
• long name not keyed correctly in group
• names have not been amended as per the legal documentation in the MEE portal

Note: a request for a name change at group level only must be notated in the personal comments. This field does not need updating where the second names or initial is already populated but not indicated on supporting documentation.

E60

Gender selected incorrectly or not changed when appropriate.

Use this error code when a customer's gender does not match supporting documentation.

Note: only amend gender for gender reassignment when the customer has provided supporting documentation. For more details see, Change of gender for Medicare enrolments.

E61

Date of birth keyed incorrectly.

Use this error code when a customer's date of birth does not match supporting documentation.

E62

Date of death or notification source incorrect.

Use this error code when a customer's date of death:

• has been keyed incorrectly
• has not been keyed
• notification of deceased source has been selected incorrectly

E63

Note: non-critical error. This must not be recorded on QBBI, only on the online Error Explanation Sheet.

Aboriginal/Torres Strait/South Sea Islander status selected incorrectly or not updated.

Use this error code when the Aboriginal/Torres Strait/South Sea Islander status:

• selected is incorrect
• was not updated

Note: where the Aboriginal/Torres Strait/South Sea Islander status is already populated but not indicated on supporting documentation the selection is not required to be updated.

E64

Eligibility and/or residency documents keyed/selected incorrectly or not entered.

Use this error code when the required eligibility or residency documents sighted or notated were:

• selected incorrectly
• keyed incorrectly
• not selected

An error is recorded if the reference date or text was omitted or incorrect.

E71

Work item not actioned completely

Use this error code if a work item has not been actioned completely as per the business rules.

An error also occurs when a work item:

• is closed in PaNDA without being processed, and
• has no comments in PaNDA/CDMS to explain the action taken

This includes where the My Health Record (MHR) error has occurred during an enrolment.

E72

Sensitive indicators not selected/selected incorrectly.

Use this error code if the sensitive indicators are not selected/selected incorrectly in CDMS as per the business rules.

E73

LHC request not actioned when appropriate.

Use this error code if a Lifetime Health Cover (LHC) letter has not been actioned:

• as per the customer's request, or
• as per the business rules

Note: it is also an error if no comments are left CDMS Personal comments when an LHC letter is issued.

E74

DVS not actioned/comments keyed when appropriate.

Use this error code when Document Verification Service (DVS) business rules are not followed / comments not included in CDMS when DVS check has been actioned.

E75

Online enrolment not actioned/closed/actioned incorrectly.

Use this error code if the online (includes Digital and Medicare Newborn Enrolment (MAENROL) Digital Medicare Enrolment and Extension (DME/DMX)) enrolment is not processed as per the business rules.

It is also an error if:

• work item not finalised appropriately in all applications, that is, PaNDA, CDMS, MEE portal and Customer First
• consent process not followed when adding a newborn to a different card
• DME/DMX application rejected incorrectly
• DME/DMX ID has not been recorded in CDMS

E76

Contact details recorded or not removed for children under 15 years of age

Contact details for children under 15 years of age must not be recorded in CDMS. Use this error code when contact details:

• are recorded
• have not been removed (when previously recorded in error by another Service Officer)

E89

More than 4 processing errors.

When 4 processing errors are detected, key all 4 error codes in the status value available.

When more than 4 processing errors are detected key, the first 3 errors with applicable codes, followed by error code E89 in the 4th field.

When more than 4 errors are made and there is a combination of processing and document errors, use E89 as the 4th error code.

Error status codes

Definition

Processing tip

E08

Insufficient, incomplete or no documentation/comments to support Medicare Safety Net confirmation.

To support action taken, use this error code when:

• the Medicare Safety Net confirmation form was incomplete
• there was no Medicare Safety Net confirmation form

Error status codes

Definition

Processing tip

E67

Medicare Safety Net registration member type keyed incorrectly or not updated.

Use this error code when the member type does not match supporting documentation.

E68

Member omitted from, included in or not removed from a family Safety Net registration when appropriate.

For the family Safety Net registration or amendment (MS016) form details, use this error code when a customer was:

• omitted
• included incorrectly, or
• not removed when required

E69

Family confirmed incorrectly.

Use this error code when the family composition does not match supporting documentation (MS032) form.

Error status codes

Definition

Processing tip

E70 Critical

Individual registered incorrectly without consent.

Use this error code when the individual or a dependant has been registered and they have not given their authority.

The MHR error email template must be completed and sent for action to the Consumer IHI and My Health Record SME team (see 'Consumer enquiries' table).

Email

Description

Subject

My Health Record processing error

Body

Complete the following information:

Your details

Date:

Your Name:

Your phone number:

Self reported or QC?

Processing details

Source office code:

Processing date:

Processor P number:

Form Type (FA081/MS004/Online/Other):

Error details (Registered/not registered incorrectly):

Customer details

Name:

DOB:

IHI:

Phone no:

Dependent details (if applicable)

Name:

DOB:

IHI:

Please attach documents