Medicare Public quality checking in Quality and Support Tool (QST) 111-22042744

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My Health Record Support team

Health Service Delivery Division - Quality Operations & Technical Support

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Enterprise Quality Framework

Medicare Safety Net Error codes

Table 1

Error codes Classification	Definition
SN0 Error-Free	No errors
SN1 Critical	Applicant cannot be uniquely identified
SN2 Critical	Bank details incorrectly added for other members
SN3 Critical	Bank Details not updated for applicant
SN4 Critical	Bank details not updated for other members
SN5 Critical	Form not signed
SN6 Critical	Incorrect Date of registration used
SN7 Critical	Incorrect or insufficient information on form
SN8 Critical	Incorrect year confirmed
SN9 Critical	Member incorrectly removed from previous family safety net
SN10 Critical	Members incorrectly added to family Safety Net
SN11 Critical	Members incorrectly removed from family Safety Net
SN12 Critical	Members not added to family Safety Net
SN13 Critical	Members not removed from family Safety Net
SN14 Non-Critical	Address not updated
SN15 Non-Critical	Incorrect member status used
SN16 Non-Critical	Incorrect Source entered
SN17 Non-Critical	Customer details not updated
SN20 Critical	Service has not been substantiated
SN21 Critical	Service substantiated without supporting documents
SN22 Critical	Substantiated amount incorrect
SN23 Critical	Incorrectly ended a family Safety Net Registration
SN24 Non-Critical	Confirmation details do not match comments
SN25 Non-Critical	Comments field not update or inappropriate
SN26 Non-Critical	Incorrect member selected for confirmation
SN27 Critical	Incorrect claimant selected for substantiation for rebate
SN28 Critical	Safety Net Not confirmed/actioned
SN29 Critical	Incorrect date used for safety net confirmation

Claims and Assessing - Patient Claims Error codes

Table 2

Error codes Classification	Definition
001	Error-free
100 Critical	Address change not notated or the address section of the claim form not completed
101 Critical	Claim form not attached to supporting documents or account not endorsed by claimant
102 Critical	Agent's authority section of claim form not completed in full
104 Critical	S4B(3) item paid without the delegate's approval
105 Critical	Patients/Claimants Medicare card number cannot be uniquely identified from details supplied
106 Critical	No evidence of confirmation of service or claim details recorded
110 Critical	Claimant's signature omitted or mismatched to claimant details
111 Critical	Inappropriate/insufficient documents to support payment
118 Critical	Statement of Benefit not attached to supporting documents
199 Critical	More than four document errors
200 Critical	Patient keyed or selected incorrectly
201 Critical	Item keyed incorrectly
202 Critical	Date of service keyed incorrectly
204 Critical	Charge keyed incorrectly
205 Critical	Item paid incorrectly as outpatient
206 Critical	Incorrect processing indicator (PI) keyed
207 Critical	Reason code not keyed, keyed incorrectly or keyed when not required
208 Critical	Medicare card number for claimant or patient keyed incorrectly or consumer ID for claimant keyed incorrectly
209 Critical	LSPN keyed incorrectly
210 Critical	Service provider keyed incorrectly
211 Critical	Notional charge not applied or applied incorrectly
212 Critical	Text transmitted not actioned appropriately
213 Critical	Telephone claim paid incorrectly
214 Critical	Items not keyed
215 Critical	SCP keyed incorrectly
216 Critical	Radiation oncology fields not keyed or keyed incorrectly
217 Critical	Over 2 year old claim paid incorrectly
218 Critical	PAYP line not keyed or keyed incorrectly
220 Critical	Miscellaneous line keyed
221 Critical	Incorrect or inappropriate manual calculation of schedule fee
224 Critical	Provider location keyed or selected incorrectly
228 Critical	Address not changed or changed incorrectly
229 Critical	Restrictive item paid incorrectly
232 Critical	Cancel and reissue cheque issue
233 Critical	EFT paid inappropriately
235 Critical	Cheque paid to provider on paid account
238 Critical	Item paid incorrectly as inpatient
239 Critical	Referral details (SR and AH) keyed incorrectly
240 Critical	Diagnostic request details (DI) keyed incorrectly
241 Critical	Pathology request details (PA) keyed incorrectly
242 Non-critical	ACRF details keyed incorrectly
245 Critical	Claimant's name or reference number keyed or selected incorrectly
247 Critical	Service verified inappropriately or has not been verified
248 Critical	Verified amount incorrect
249 Critical	Additional item lines keyed without justification
250 Critical	Item lines rejected in error
253 Critical	EFT details keyed or stored incorrectly
310 Critical	Two way claim form not transmitted/transmitted incorrectly
311 Critical	Work item not actioned completely
312 Critical	AODR not actioned in patient claim form
313 Non-critical	Comments not keyed when appropriate or completed incorrectly
314 Critical	Claim adjustment completed incorrectly
315 Critical	Letter created contains errors which impacts on privacy implications
316 Non-critical	Letter created contains minor errors which does not impact on customer privacy
PC03 Critical	Incorrect letter/advice sent to claimant or provider or patient
PC08 Critical	Business/Third party claim processed incorrectly
PC09 Non-critical	MOA - Documents should not be associated together in PaNDA
PC10 Critical	MOA - Service details should have been amended as a minor discrepancy
PC11 Critical	Letter not issued to the customer when appropriate
PC13 Non-critical	Customer details not recorded in PaNDA

Claims and Assessing - Patient Claims Payments Error codes

Table 3

Error codes Classification	Definition
E001	Error-free
E06 Critical	Address details omitted
E11 Critical	Name/s incomplete or omitted
E16 Critical	Signature omitted or incomplete
E55 Non-Critical	Personal contact details not keyed or keyed incorrectly
E56 Critical	EFT banking details keyed incorrectly
CA1 Critical	Storing bank details for customers under 14 years of age
CA2 Critical	Selecting incorrect Notification Source on CDMS (should always be EFT Details Collection Form)
CA3 Critical	Not updating customers bank details who have filled out consent to nominate bank account (Q7)
CA4 Critical	Form signed by verified POA (already in CDMS) and returned in error
CA5 Critical	Form was signed by someone other than the customer
CA6 Critical	Applicant has not signed the form and banking details have been updated
CA7 Critical	Medicare Card Number do not match the applicants details and application processed
CA8 Critical	Bank details stored/lodged against the incorrect customer
CA9 Critical	Form was not signed by customer and no comments left to say customer was contacted & declaration read out
CA10 Non-Critical	Title not updated or updated incorrectly
CA11 Critical	Mailing address not updated incorrectly updated or only updated in personal

Medicare Eligibility Error codes

Table 4

Error codes

Classification

Definition

001

Error-Free

E06

Critical

Address details omitted

E08

Critical

Insufficient, incomplete or no documentation/comments to support Medicare Safety Net confirmation.

E10

Critical

Reason for copy or transfer application omitted

E11

Critical

Name/s incomplete or omitted

E12

Critical

Gender omitted

E13

Critical

Insufficient documentation to support enrolment action taken for child in state/foster care

E16

Critical

Signature/declaration omitted or incomplete

E19

Critical

Insufficient inappropriate or no documents to support enrolment action taken

Note: this includes DME (Digital Medicare Enrolment) applications where documents haven't been accepted or VEVO has not been completed in MEE portal

E20

Critical

Insufficient or incorrect identification to support enrolment amendment action taken

E22

Critical

DIAC/Applicant for permanent residency

Insufficient, inappropriate or no documentation to support enrolment action taken

Note: this includes DME applications where documents haven't been accepted or VEVO has not been completed in MEE portal

E23

Critical

Returning residents/citizens and New Zealand citizens residing permanently in Australia

Insufficient, inappropriate or no documentation to support enrolment action taken

E24

Critical

New enrolment Reciprocal Health Care Agreement

Insufficient, inappropriate or no documentation to support enrolment action taken

E39

Critical

Operational Information

Medicare Public quality checking in Quality and Support Tool (QST) 111-22042744

Contact Details

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Medicare Safety Net Error codes

Claims and Assessing - Patient Claims Error codes

Claims and Assessing - Patient Claims Payments Error codes

Medicare Eligibility Error codes