Cheque trace requests for patient claims in Medicare 011-43090010

A cheque trace may be requested by either the:

• provider or their representative
• claimant

Cheque trace requests may only be made when the cheque has been presented. They can be lodged over the phone, in person at a Medicare Service Centre, or in writing.

The Resources page contains more details about trace requests from a claimant or health professional.

Note: if a request has been made for an Electronic Funds Transfer (EFT) trace, see EFT dispute policy.

If the claim is a Pay Doctor via Claimant (PDVC) cheque or bulk bill cheque, the Service Officer may disclose information to providers for the purposes of:

• processing Medicare claims
• making appropriate payments in relation to those claims
• administering any other legislative provisions governing the Medicare program

If a claim has been finalised the Service Officer can answer queries about the benefit amount if

• a payment in favour of the provider has been issued, and
• only if the provider or representative can identify the service the payment relates to

A claim is considered to be finalised when either:

• the claim has been assessed and payment issued for the Medicare benefit
• a statement has been issued explaining why there is no benefit payable

If there is a dispute between the claimant and the provider regarding the payment of an account and the cheque has been banked, a trace of the funds may be requested to determine their whereabouts.

Where a trace request is made for a PDVC cheque and the details of the trace have been received, Medicare cannot release the bank account information to the requestor due to privacy concerns.

A health professional requests a cheque trace. The trace details show that the cheque was deposited into a bank account that is not related to the provider. For example, the name of the provider does not match the name of the bank account. The bank account details of where the money was deposited must not be given to the provider.

Note: checking PDS, BRNA or BRVA (for Veterans Affairs Processing claim payments) for health professional bank account information may be useful to confirm the account details returned by the Reserve Bank of Australia (RBA).

When in doubt about the names of the provider or claimant and the name of the bank account matching, confirm with the person making the request the name of the account the money should have been deposited into.

When the funds are not in the nominated bank account of the cheque payee, the RBA will seek authorisation from Administered Treasury, Services Australia Canberra to retrieve the funds. The RBA requires a statutory declaration from the payee of the cheque and the receiving financial institution before the RBA will action any third party request to recall funds.

When Medicare receive a request from a cheque payee, a statutory declaration form can be sent to them if required. When the payee returns the statutory declaration, a third party request is sent to the RBA.

See Release of claims information in Medicare.