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
• the claim includes individual items more than $9,999.99. This is because of system limitations. Staff must tell customers to complete a Medicare claim form (MS014). See the Resources page for a link to the form.

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

Note: when customers include 5 services in their claim, the following message shows. '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.'

Each claim must include:

• a receipt/invoice for each service. Customers can upload documents that meet the following:
• a combined file size no larger than 5MB
• a maximum of 10 files
• are in PDF, JPG, PNG, GIF or BMP format. See the Resources page for information on the Services Australia website about proof of payment and taking and scanning clear photos and documents
• service details, including:
• item number
• date of service. This cannot be in the future or more than 2 years ago
• charge amount
• the customer’s current bank account details

Customers can:

• sign in to their myGov account through the myGov website or the myGov app
• select Medicare
• from their Medicare online account homepage, select:
• myGov app > Make a Medicare claim
• myGov website > Make a claim in the Quick links tile, or
• myGov website > Make a claim menu > Make a Medicare claim

See online guide Medicare online account help - Make a Medicare claim.

The Resources page contains links to all digital support products.

When claims are submitted, customers can track their progress online. See Track Medicare claims online.

Has the invoice been paid in full?

• Yes, the Medicare benefit is paid into the customer's bank account. This is usually within a day of the claim being processed
• No,
• a cheque payable to the doctor or health professional is sent 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 on the history page
• press [F1]
• a This is an Electronic Home Based Medicare Claim message shows at the bottom of the page

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

After 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 claim includes individual items more than $9,999.99. This is because of system limitations. Staff must tell customers to complete a Medicare claim form (MS014). See the Resources page for a link to the form

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

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

Note: when customers include 5 services in their claim, the following message shows. '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.'

Each claim must include:

• a receipt/invoice for each service. Customers can upload documents that meet the following:
• a combined file size no larger than 5MB
• a maximum of 10 files
• are in PDF, JPG, PNG, GIF or BMP format. See the Resources page for information on the Services Australia website about proof of payment and taking and scanning clear photos and documents
• service details, including:
• item number
• date of service. This cannot be in the future or more than 2 years ago
• charge amount
• the customer’s current bank account details

Customers can:

• sign in to the Express Plus Medicare mobile app
• from the home screen, select Make a claim in Claims

See online guide Medicare online account help - Make a Medicare claim

When claims are submitted, customers can track their progress online. See Track Medicare claims online.

Has the invoice been paid in full?

• Yes, the Medicare benefit is paid into the customer's bank account. This is usually within a day of the claim being processed
• No:
• a cheque payable to the doctor or health professional is sent 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

When a Service Officer processes the claim:

• claiming information shows on the customer’s Medicare Claim History Statement
• it shows in the claim history the following day