Understanding rejections

There are two kinds of rejections.

1/ Failure at the point of submission.

There are 255 reasons at present why a claim might be rejected.  Some examples might be a Token Key Failure, the location certificate has expired or perhaps even corruption of data during transmission.

In this case there is no report at all because the claim did not reach Medicare Australia or was not recognized by Medicare Australia.

2/ Failure inside the processing report.

If the claim is accepted for processing then there are three outcomes.

• Accepted totally
• Rejected totally
• Rejected partially

The processing report from Medicare should explain the reason for rejection. 

e.g. expired Provider #, patient not recognized, incompatibility of service codes etc.

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