Patient claim requirements for payment of Medicare benefits 011-43010040

Claiming Medicare benefits by person on the same Medicare card

Table 1: this table lists the ways in which a Medicare benefit is paid when a person on the same Medicare card attends a service centre on behalf of the claimant.

Where the claimant:	the Medicare benefit is paid:	Explanation
has bank account details stored	EFT to the claimant.	The person on the same Medicare card may sign the printed receipt, even though it displays the bank account details of the claimant.
does not have bank account details stored	EFT to the claimant.	All manual patient claims will be paid via EFT from 1 July 2016. Where the claimant does not have valid EFT details stored in CDMS or cannot provide valid temporary or permanent EFT details at the time the claim is submitted , the payment for the claim will be ‘HELD’ until EFT details have been provided.

Patient claims minimum payment times in days

Table 2: this table lists the minimum payment times in days for patient claims. Note: the times are current at the date of publication.

Patient claims	Manual - Cheque	Manual - EFT	Electronic claiming (Online and Easyclaim) - Cheque	Electronic claiming (Online and Easyclaim) - EFT
Pay doctor via claimant Payee code: 2	18	N/A	15	N/A
Pay doctor via claimant (GP) Payee code: 2	16	N/A	14	N/A
Pay claimant (not necessarily cardholder) Payee code: 9	10	0	10	0
Patient Claims adjustment Payee code: 2,9	0	N/A	0	N/A
Medicare patient claim Webclaim Payee code: 9	N/A	N/A	N/A	1
Medicare patient claim webclaim (Pay doctor via claimant) Payee code: 2	N/A	N/A	14	N/A

Simplified billing claims minimum payment times in days

Table 3: this table lists the minimum payment times in days for simplified billing claims. Note: the times are currently at the date of publication.

Simplified billing claims

Manual - EFT/Credit EFTPOS

Electronic claiming (Online and Easyclaim) - Cheque

Electronic claiming (Online and Easyclaim) - EFT

All claims (Billing agents and private health insurers)

Payee code: 8

N/A

Cheque payment services standards

Table 4: this table describes the cheque payment service standards for cheque claims.

Delivery location	Approximate time frame
Canberra - Canberra	4 business days
Canberra - Interstate metro	5 business days
Canberra - Rural	6 business days
Canberra - Remote	7 business days (dependent on the number of deliveries to that area each week)

Forms

Medicare Claim form (MS014)

Claims details verified by phone (VG4)

Letters

Services Australia has endorsed the letter or electronic message for use. It is the latest version. Do not use locally produced letters or electronic message.

Letters and electronic messages

Service Officers can start the following letter from CDMS or DMC. See Digital Messaging Capability (DMC) to create and send letters.

Z0828 - Medicare claim needs more information

Operational Information