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Claiming Medicare benefits online 133-02090040



This document outlines how customers can submit and track their Medicare claims online. They can do this using their Medicare online account through mGov or the Express Plus Medicare mobile app.

Eligibility

Customers can claim a Medicare benefit if they have:

  • current Medicare eligibility
  • valid bank details recorded (for fully paid invoices)
  • a valid address recorded
  • a valid receipt/invoice that shows:
    • patient name
    • date of service
    • item number
    • provider number
    • payee provider number (if applicable)
    • referral provider details (if applicable)
    • referral date (if applicable)
    • cost of service
    • if the invoice is unpaid, partially paid, or paid in full
    • if the invoice item was for an 'admitted patient' or 'in-patient'

Note: an account number is not required for an invoice/receipt to be valid. See Account and receipt documents for Medicare claims processing.

The Process page explains when customers cannot submit their claim online.

Submitting a claim

The quickest and easiest way for customers to get their Medicare benefit is by asking their doctor to submit the claim for them. The customer will get their Medicare benefit paid into their bank account.

If this service is not available, customers can pay their invoice in full and submit their claim online. They can do this if they have set up access to Medicare self service.

When claims over $9,999.99 are submitted through the customer’s Medicare online account or Express Plus Medicare mobile app, see Process a claim with a minor difference table on Process digital self service claims for processing information.

Tracking the progress of a claim online

Customers can view the status of their recently submitted Medicare claims online (if they are the claimant) using their:

  • Medicare online account through the myGov website or myGov app, or
  • Express Plus Medicare mobile app

See Track Medicare claims online.

The Resources page contains links to more information and support. It also explains upload error messages for the app.

Medicare self service - checking, cancelling and enabling

Troubleshooting Medicare self service

Claims processing in Medicare

Patient claim requirements for payment of Medicare benefits

Medicare fraud abuse and inappropriate practice

Identifying customer vulnerability and risk issues

Track Medicare claims online