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:
• less than $1, or
• $10,000 or more
  This is because of system limitations. An error message MOA-E4111 shows when customers try to submit a claim that does not meet the allowable charge amount limits. It tells them they need to use the 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

On the Before you start page, customers are given upfront messaging that tells them:

• to check they have not already submitted a claim, with links to View recent claims and View claims history
• to make a Medicare claim they will need:
• invoices for the services they are claiming
• proof of payment if they paid for the services in full
• if they are claiming in-hospital items through their private health fund, complete a Two-way claim form and upload it with their invoice
• if their claim has any amount that is $10,000 or more, they will need to use the Medicare Claim form
• they need to make a separate claim for each health professional and each patient. They can include multiple services on one 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

See Process digital self service claims.