Bulk Bill quality checking processing 111-22090010

Error-free status code

Definition

Processing tip

001

Error-free

Transaction is error-free

Error status codes

Definition

Processing tip

D02

(DB1) Service provider details incorrect or not completed and not detected by the Service Officer.

The address of the service provider must match the practice location. Where the practitioner has more than one practice location recorded with Services Australia, the provider number used should be applicable to the practice location where, or from which, the service was provided.

It is an error when a PO Box or group link is on the DB1 and not detected by the Service Officer.

D07

(DB1) Payee provider details not completed when appropriate and not detected by the Service Officer.

DB1 forms have been designed to enable benefits for a claim to be directed to a practitioner other than the one who rendered the service. For example, where a short term locum is acting on behalf of the principal doctor.

It is an error when the payee provider details are incomplete on the DB1 and not detected by the Service Officer.

D08

DB1 not signed by service provider and not detected by the Service Officer.

It is an error when the provider signature is omitted from the DB1.

Note: a signature stamp is not acceptable for manual or scanning.

D09

(DB1) Witness signature or name of witness not present and not detected by the Service Officer.

It is an error when the witness name or signature is omitted from the DB1.

It is not an error if the date of the witness is missing.

Note: a signature stamp is not acceptable for manual or scanning.

D11

(DB1) Claim date omitted or incorrect and not detected by the Service Officer.

When a provider number is closed and the claim date is after the close date (but DOS is within the open date), the system will not accept that claim date. It is acceptable to key the date of claim as the date the provider number has closed due to system restraints.

It is an error when the claim date is omitted or incorrect on the DB1 and not detected by the Service Officer.

It is not an error when the claim date is omitted or incorrect and the Service Officer has used the date the header is signed as the claim date.

D12

DB1 used when DB1H should have been used and not detected by the Service Officer.

It is an error when a provider has submitted in-hospital services on a DB1 and the Service Officer has failed to notate that the relevant correspondence has been sent to the provider advising future claims will be rejected if incorrect stationery is used.

A photocopy or fax of a blank header is acceptable when the provider runs out of stationery. The provider must complete all sections each time the claim is submitted and not use a photocopy of previously completed and signed DB1.

D13

DB1H used when DB1 should have been used.

It is an error when a provider has submitted out-of-hospital services on a DB1H and the Service Officer has failed to notate that the relevant correspondence has been sent to the provider advising future claims will be rejected if incorrect stationery is used.

A photocopy or fax of a blank header is acceptable when the provider runs out of stationery. The provider must complete all sections each time the claim is submitted and not use a photocopy of previously completed and signed DB1.

D14

(DB2-DB5) Incorrect type of voucher.

It is an error when an incorrect voucher type is submitted and not detected by the Service Officer.

Note: it is a legislative requirement that claims for Medicare benefit must be submitted on an approved form.

D16

(DB2, DB3 and DB4) Voucher not signed by patient or reason for omission of signature omitted or not sufficient.

It is an error when the patient (or responsible person) does not sign the voucher or the explanation for no signature is insufficient or inappropriate and not detected by the Service Officer.

Note: it is not sufficient for the provider to notate 'unable to sign' or 'left surgery before signing’. (Exception DB1b stationery) for all channels.

D17

(DB2-DB5) Patient's details insufficient to uniquely identify the Medicare card number.

It is an error when a patient cannot be identified uniquely from details supplied and not detected by the Service Officer.

Note: if a patient's Medicare number is not available, a provider may claim by including the patient's name, date of birth and current address on the voucher. If eligibility cannot be confirmed, the service for the patient must be rejected.

D18

(DB2-DB5) Incorrect patient nominated or patient not nominated on voucher and not identified by the Service Officer.

It is an error when a card number has been imprinted or written on a voucher and:

• no patient sub numerate was indicated on voucher
• incorrect patient sub numerate was indicated on voucher

and was not detected by the Service Officer.

It is not an error when there is no sub numerate indicated on the voucher and only one person on the card.

D19

(DB2-DB5) Date of service not shown on voucher or illegible and not detected by the Service Officer.

It is an error when the date of service is omitted or illegible and not detected by the Service Officer.

Note: if the Service Officer has confirmed service date details, verification must be present.

D20

(DB2-DB5) Item number or description of service not written on voucher and not detected by the Service Officer.

It is an error when the item number or description is omitted or illegible and not detected by the Service Officer.

Note: if the Service Officer has confirmed the item numbers with the provider, verification must be present.

D23

Benefit assigned not written on voucher and not detected by the Service Officer.

It is an error when the benefit assigned is not indicated on the voucher and not detected by the Service Officer.

D24

(DB2-DB5) Requesting or referring practitioner's name and provider number or name and address not written on voucher when appropriate and not detected by the Service Officer.

It is an error when the referring or requesting provider details are omitted or incorrect on the voucher and not detected by the Service Officer.

Note: if the Service Officer has confirmed referring or requesting provider details, verification must be present.

D26

(DB2-DB5) Date of request or referral not written on voucher when appropriate and not detected by the Service Officer.

It is an error when the referring or requesting date is omitted or incorrect on the voucher and not detected by the Service Officer.

Note: if the Service Officer has confirmed the referring or requesting date, verification must be present.

D29

Service provider's details not indicated on voucher or different to header and not detected by the Service Officer.

It is an error when the service provider details are:

• omitted from the voucher
• incorrect
• different to the claim header

and not detected by the Service Officer.

Note: if the Service Officer has confirmed service provider details, verification must be present.

D30

S4B3 item paid without delegate's approval.

It is an error when a delegate's approval was not indicated on documentation for payment of S4B3 items and not detected by the Service Officer.

D31

(DB2 and DB4) Radiation oncology equipment number not indicated on voucher and not detected by the Service Officer.

It is an error when an equipment number is not endorsed on the voucher and not detected by the Service Officer.

Note: if the Service Officer has confirmed equipment number details, verification must be present.

D32

No documents to support payment.

It is an error when a claim is processed without supporting documentation.

Note: if documentation is recovered after the quality check process is complete, the error code is not to be reversed.

Quality Checkers must confirm the service and endeavour to retrieve the documents.

Where confirmation of the service or retrieval of documents cannot be achieved, this should be escalated through State processes.

D34

Practitioner or patient copy of vouchers submitted with no justification and not detected by the Service Officer.

It is an error when the patient copies or photocopies are submitted and accepted by the Service Officer without a provider covering letter.

D39

More than 4 document errors.

Where 4 document errors are detected key all 4 error codes.

When more than 4 document errors are detected key the first 3 errors with their applicable codes and key 'D39' as the 4th error.

When more than 4 errors are made and there is a combination of document and processing errors key 'D89' as the 4th error.

Error status codes

Definition

Processing tip

D40

Payee provider keyed incorrectly or omitted.

Manual

It is an error when the Service Officer has:

• not keyed the payee provider
• keyed the incorrect payee provider.

Note: this error status code does not apply to online bulk bill.

D41

Claim ID keyed incorrectly.

Manual

It is an error when the claim ID does not match supporting documentation.

Note: this error status code does not apply to online claiming.

D42

Date of lodgement keyed incorrectly.

Manual

It is an error when the date of lodgement (DOL) keyed does not match supporting documentation when indicated.

Note: if a claim has been transmitted twice by the provider, the Service Officer should process from the earlier DOL transmission and delete the second transmission.

Note: this error status code does not apply to online claiming.

D43

Service provider keyed incorrectly.

Manual

It is an error when the service provider details do not match supporting documentation.

Note: this error status code does not apply to online claiming.

D44

Incorrect card number keyed or selected.

Manual

It is an error when the card number keyed differs to the voucher submitted or patient records.

Online

It is an error when the incorrect card number was supplied and the Service Officer did not reject the claim.

D45

Patient keyed or selected incorrectly.

Manual

It is an error when the patient keyed or selected differs to the patient on the voucher submitted.

Note: when there is multiple card members and no patient sub-numerate indicated a Service Officer cannot assume the person who signed the voucher is the patient.

Online

It is an error when the patient selected differs to the transmission details.

D46

Item keyed or selected incorrectly.

Manual

It is an error when the item number keyed does not match the supporting documentation.

Note: this error status code does not apply to online claiming.

D47

Incorrect date of service.

Manual

It is an error when the date of service keyed does not match supporting documentation.

Note: this error code does not apply to online claiming.

D48

Incorrect benefit assigned.

It is acceptable for the Service Officer to acknowledge a difference between the benefit assigned, and a system generated benefit up to a difference of $5.00 for a derived fee item, and $10.00 for all other items. Any more than this amount should be investigated.

Manual

It is an error when the Service Officer:

• keyed the incorrect benefit assigned
• has allowed payment of a different amount without justification

Online

It is an error when the Service Officer has altered the benefit assigned from the transmitted data to allow payment.

Note: where the Service Officer has manually calculated the schedule fee incorrectly and this has resulted in an incorrect payment, this is an error.

D49

Incorrect processing indicator (PI) used.

This error occurs when a restriction should have been overridden, but the wrong PI was used.

Manual

It is an error when the wrong PI has been keyed.

Online

It is an error when a text message supports the restriction override, however the Service Officer has used the incorrect PI.

Note: only highest PI code used is stored by the system.

If a Service Officer has incorrectly overridden a restriction then the error would be D51.

D50

Incorrect reason code keyed or omitted.

All channels

It is an error if a reason code was not entered when required to process the claim or the wrong reason code was entered.

Note: it is not an error if the system has inserted the reason code.

D51

Restrictive item paid incorrectly.

All channels

It is an error when the Service Officer has inappropriately overridden a restriction.

D52

Incorrect modifier used.

Manual

It is an error when the Service Officer has used the incorrect modifier.

Note: this error code does not apply to online claiming.

D53

Incorrect SR or AH referring details.

This error code applies to specialist (SR) and allied health (AH) referral lines that appear on history including the keying of SUB/CON in the RSN field.

Manual

It is an error when the referral line keyed differs to the voucher submitted.

Online

It is an error when the SUB/CON keyed in the RSN field is incorrect.

Note: it is not an error when the system has generated a referral line with RSN SGN.

D54

Incorrect DI requesting details.

Manual

It is an error when the diagnostic (DI) request details do not match voucher submitted.

Note: this error code does not apply to online claiming.

D55

Incorrect PA requesting details.

Manual

It is an error when the pathology (PA) request details do not match voucher submitted.

Note: this error code does not apply to online claiming.

D56

Item lines omitted.

Manual

It is an error when the Service Officer has not keyed the item lines indicated on the voucher.

Note: this error code does not apply to online claiming.

D57

Additional item lines paid or keyed without justification.

All channels

It is an error when additional item lines have been paid or keyed without justification.

Note: it is not an error when additional lines have been keyed in accordance with business rules.

D59

Item lines rejected in error.

All channels

It is an error when the Service Officer has rejected item/s lines, when not in accordance with business rules.

D60

LSPN keyed incorrectly.

Manual

It is an error when the Location Specific Practice Number (LSPN) for a diagnostic imaging or oncology item does not match voucher submitted.

Note: this error code does not apply to online claiming.

D61

SCP keyed incorrectly.

Manual

It is an error when the SCP (Specimen Collection Point) for a pathology item does not match voucher submitted.

Note: this error code does not apply to online claiming.

D89

More than 4 processing errors.

Where 4 processing errors are detected key all 4 error codes.

When more than 4 processing errors are detected key the first 3 errors with the applicable code and key 'D89' as the 4th error.

When more than 4 errors are made and there is a combination of processing and document errors key 'D89' as the 4th error.