Incomplete or incorrect Medicare claims forms 011-43010050
Expand allThis page contains information on the process Service Officers must complete when no Medicare card number has been supplied on the claim form. It also contains information on what to do when the claimant address details supplied on the claim form differ from the group contact address, and what to do when there is no claimant signature on the claim form or it has been supplied in the wrong section of the claim form.
On this page:
Claimant or patient can be uniquely identified, and Medicare number is missing from claim
Claimant or patient cannot be uniquely identified, and Medicare number is missing from claim
Patient not enrolled on Medicare card quoted on claim form
No claimant details supplied on claim form
Claimant is group contact and address recorded is different to claim form
Signature missing or in the wrong section of the claim form
Claimant or patient can be uniquely identified, and Medicare number is missing from claim
Table 1: this table describes what to do when the claimant or patient can be uniquely identified from the claim form or patient invoice, and Medicare number has not been supplied on the claim form.
Action | |
Search CDMSLog on to Consumer Directory Maintenance System (CDMS). Search for the Medicare card using the details provided on the claim form. See Register a customer for Medicare in the Consumer Directory Maintenance System (CDMS). | |
Claimant or patient cannot be uniquely identified, and Medicare number is missing from claim
Table 2: this table describes what to do when the claimant or patient cannot be uniquely identified from the information supplied on the claim form, and the Medicare number is missing. There are claimant contact details are listed on the claim form.
Action | |
Contact claimantAttempt to contact the claimant using the details provided on the claim form. See Telephone standards for Medicare and Health Delivery Was contact made with the customer?
| |
Unable to contact customer
Procedure ends here. | |
Phone contact was madeConduct a security check to confirm their identity. See Authenticating a Medicare customer. Tell the claimant that a Medicare card number was not supplied on the claim form. | |
Record Medicare card numberRecord the verified Medicare card number using either:
The Resources page contains a link to the VG4 form. | |
Process claimProcess the claim with the correct Medicare card number. |
Patient not enrolled on Medicare card quoted on claim form
Table 3: This table describes what to do when a patient is not enrolled on the Medicare card number quoted.
Item | Situation and action |
1 | Where the patient can be uniquely identifiedSearch for the Medicare card number in the Consumer Directory Maintenance System (CDMS) and process the claim using the correct card number. |
2 | Where the patient cannot be uniquely identified
See Digital Messaging Capability (DMC) - Health to create and send letters. |
3 | Where the card number is flagged as lost or stolen
See Digital Messaging Capability (DMC) - Health to create and send letters. |
4 | Where the issue number is more than 12 months old
See Digital Messaging Capability (DMC) - Health to create and send letters Note:
|
No claimant details supplied on claim form
Table 4: this table describes what to do when a claimant provides a Medicare number only on the Medicare claim form and no personal details have been supplied.
Action | |
Contact claimantContact the claimant using details stored in the Consumer Directory Maintenance System (CDMS). See Telephone standards for Medicare and Health Delivery. Note: if contact is unsuccessful, process the claim using the address stored in CDMS. | |
Confirm detailsAsk the claimant to confirm their details. When checking their address, verify if it is a permanent (p) address or a temporary (t) address. Update address details if required. Note: Service Officers must not in any circumstances release the address stored in CDMS to the claimant. | |
Record address detailsRecord the address details supplied using either:
The Resources page contains a link to the VG4 form. | |
Process claimProcess the claim. |
Claimant is group contact and address recorded is different to claim form
Table 5: this table describes what to do when the claimant is group contact and the address details supplied on the claim form is different to recorded details in CDMS.
Action | |
Contact claimantContact claimant to verify permanent address change applies to all persons on the card:
Note: if the Yes or No box on the claim form has not been checked, record the address as temporary (t). | |
Record address details as permanentRecord address details as permanent (p). Pay the claim. See Patient claims processing in Medicare when reversing the claim due to incorrect claimant card number. | |
Record address details as temporaryRecord address details as temporary (t). Pay the claim. |
Signature missing or in the wrong section of the claim form
Table 6: this table describes what to do when there is no claimant signature on the claim form or it has been supplied in the wrong section of the claim form.
Action | |
Where contact details are available, contact the claimant
| |
Authenticate the customerAuthenticate the customer to confirm their identity. Note: if identity cannot be confirmed, send Z0828 - Medicare claim needs more information letter. See: | |
Confirm details with claimantTell the claimant they are being contacted regarding the claim they submitted with the below details:
Confirm with the claimant that they either:
Read out to the customer the Claimant Declaration. See the Resources page for the Claimant Declaration text to read to the customer. Note: if the claimant cannot verify that they forgot to sign the claim form, or signed in the wrong place:
See Digital Messaging Capability (DMC) - Health to create and send letters. | |
Note conversationNote this conversation using either:
The Resources page contains a link to the VG4 form. | |
Process claimProcess the claim accordingly. |