Claiming Medicare benefits online 133-02090040

Customers cannot submit a Medicare claim using their online account if:

• their Medicare entitlement has expired
• the service was not for someone listed on their Medicare card
• the service was provided more than 2 years ago
• they were bulk billed for the service
• they have a BI, CMBO or MPI flag on their Medicare record

When claims over $9,999.99 have been submitted via digital self service, see Process a claim with a minor difference table on Process digital self-service claims.

Note: due to system limitations, claims for items more than $9,999.99 are required to be submitted following the manual process using a Medicare claim (MS014). The Resources page has a link to MS014.

Customers can include up to 5 services in the one claim. Each service must be for the same patient, and provided by the same health professional.

Note: once a customer includes 5 services in their claim, the following text will display. 'You have reached the maximum number of items that you can add to your claim. If you have more items showing on your invoice/receipt we will process these items for you.'

• Receipt/invoice for each service. They need to upload documents (the Resources page has a link to the Services Australia website about proof of payment and advice on taking/scanning clear photos and documents)
• combined file size must be no larger than 5MB
• up to 10 files can be uploaded
• format must be PDF, JPG, PNG, GIF or BMP
• Service details:
• item number
• date of service cannot be in the future or more than 2 years ago
• charge amount
• Their current bank account details

For more information on guiding customers through the online process, use digital support products available.

The Resources page has links to Digital Support Products.

Once the claim is submitted, customers can track it’s progress online. See Track Medicare claims online.

Has the invoice been paid in full?

• Yes, the Medicare benefit goes into the customer's bank account. This is usually within a day once the claim is processed
• No,
• a cheque payable to the doctor or health professional posts to the customer's mailing address
• they need to give the cheque to the doctor or health professional.
• they will also need to pay the rest of the invoice

Service Officers can identify these claims:

• place cursor in CLID line above the claim information in the history page
• press [F1]
• text displays at the bottom of the screen: This is an Electronic Home Based Medicare Claim

Or press [SHIFT + F2] in the final column under the CT heading. The claim lists as HBC - home based claim.

Once the claim is processed, the claims history will include the claim information.

Customers cannot submit a Medicare claim using the app if:

• their Medicare entitlement has expired
• the service is not for someone listed on their Medicare card
• the service was provided more than 2 years ago

The following may be submitted, but will be assessed by a Service Officer:

• the patient was an in-patient at a hospital or approved day facility
• the service was bulk billed
• the customer has a BI, CMBO or MPI flag on their Medicare record

When claims over $9,999.99 have been submitted via digital self service, see Process a claim with a minor difference table on Process digital self-service claims.

Note: due to system limitations, claims for items more than $9,999.99 are required to be submitted following the manual process using a Medicare claim (MS014). The Resources page has a link to MS014.

Customers can include multiple services in the one claim. There is no limit. Each service must be for the same patient, and provided by the health professional.

Note: once a customer includes 5 services in their claim, the following text will display. 'You have reached the maximum number of items that you can add to your claim. If you have more items showing on your invoice/receipt we will process these items for you.'

• Receipt/invoice for each service. They need to upload documents (the Resources page has a link to the Services Australia website about proof of payment and advice on taking/scanning clear photos and documents)
• combined file size must be no larger than 5MB
• up to 10 files can be uploaded
• format must be PDF, JPG, PNG, GIF or BMP
• Service details:
• item number
• date of service cannot be in the future or more than 2 years ago
• charge amount
• Their current bank account details

For more information on guiding customers through the online process, use digital support products available.

The Resources page has links to Digital Support Products.

Once the claim is submitted, customers can track it’s progress online. See Track Medicare claims online.

Has the invoice been paid in full?

• Yes, the Medicare benefit goes into the customer's bank account, usually within a day once the claim is processed
• No, a cheque payable to the doctor or health professional posts to the customer's mailing address. They need to give the cheque to the doctor or health professional. They will also need to pay the rest of the invoice

Once a Service Officer processes the claim:

• Claiming Information displays on the customer’s Medicare Claim History statement
• Claims display in the claim history the following day