How to understand your Medicare claims history statement - Medicare

How you can check your provider’s name

For pathology and diagnostic imaging services, your Medicare Claims History Statement shows the name of the provider who reported the results. This isn’t the health professional who referred you, collected the sample or took the scans.

For optometry services, your Medicare Claim History Statement lists the optometrist’s name, not the company’s name.

What the date of service means

The date in your Medicare Claims History Statement could be either of the following:

for pathology or diagnostic imaging services the date the sample was collected, or the scan was done
the date you visited your provider.

This is the date your provider told us.

Why there are multiple Medicare item numbers

You may see more item numbers for the same date of service than you expected. This is because of the following reasons:

your provider may have provided several services in one visit
for pathology and diagnostic services, often there’s more than one test
if you’ve been to hospital, treatment often involves many services from different providers, some you may not have seen in person.

You can search Medicare item numbers at Medicare Benefits Schedule online from the Department of Health and Aged Care website.

How a Medicare benefit is paid

Your Medicare Claims History Statement shows how the Medicare benefit was paid for each service. The benefit paid may not cover the full amount charged by your provider.

EFTPOS

We’ve paid the benefit into the bank account linked to the debit card provided at the medical practice.

EFT to Claimant

We’ve paid the benefit into the claimant’s bank account recorded with Medicare. Read more about checking bank details.

Bulk Bill

You won’t get a Medicare benefit for this service because we pay your provider directly. Your provider accepts the benefit as the full payment for the service. Read more about bulk billing.

Cheque to Provider via Claimant

We’ve paid the benefit by cheque in the provider’s name. The cheque has been sent to the claimant’s postal address. The claimant needs to give the cheque to the provider as part of the payment for the service.

Private Health

We’ve paid the Medicare benefit directly to your private health insurer or billing agent. This applies to private patient services in a public or private hospital. You won’t get payments for this service.

How to check if you got your Medicare benefit

If you get paid a Medicare benefit, this will show in your Medicare Claims History Statement.

If you have children under the age of 14, you can also view their Medicare Claims History Statement. Read more about what happens when your child turns 14.

If you’re unsure you’ve been paid a Medicare benefit, you can check the following:

all your bank accounts
if we have your correct bank details
the payment method at the time of the service.

If we don’t have your correct bank account details, we may hold your payment. Read more about how we pay your held benefits in getting Medicare benefits.

If your claim was rejected, it won’t appear on your Medicare Claims History Statement. Read more about Medicare claims.

Understand your Medicare Claims History Statement

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