Medicare claims

Claim Medicare benefits at your doctor’s office

The quickest way to claim your Medicare benefit is at your doctor’s office straight after you pay.

To do this you need to both:

• be enrolled in Medicare
• show your Medicare card.

If your doctor bulk bills, you don’t need to pay.

When you pay at the doctor’s office, ask if they can make an electronic claim for you. If they can, they’ll do it on the spot. We’ll process the claim as soon as possible and pay your Medicare benefit into either:

• the account for the EFTPOS card you used to pay
• the bank account you’ve registered with us.

You may need to give us proof of payment when you claim. Find out more about proof of payment.

If we’re paying into your bank account, we need your correct bank account details. Find out how to update your Medicare details.

If you pay using cash, we’ll pay your benefit electronically into the bank account you have registered with us.

Claim Medicare benefits online

Using the Medicare online account

If your Medicare online account is linked to myGov, sign in now and select Make a claim.

Sign in to myGov

If you don’t have a myGov account or a Medicare online account, you’ll need to create them.

When you submit your claim online, you’ll usually get your benefit within 7 days.

We’ll pay your benefit into the bank account you’ve registered with us. You can register your bank details using your Medicare online account or the Express Plus Medicare mobile app.

We can’t accept online claims for services over 2 years old.

You can read our online guides about:

• submitting your Medicare claim using your online account
• updating your bank details using your online account.

Using the Express Plus Medicare app

You can make a claim with the Express Plus Medicare mobile app on your mobile phone. Don’t submit a claim if your doctor has done it for you.

To use the app, you need a Medicare online account linked to myGov. If you don’t have these accounts, you’ll need to create them.

Before you start your claim, make sure you have both:

• your invoice and receipt
• details of the service you want to claim.

When you claim, we’ll ask you to either give us or confirm your bank account details.

When you make a claim through the app, you’ll usually get your benefit within 7 days. We pay electronically into the bank account you have registered with us.

Find out how to download the Express Plus Medicare mobile app.

Claim Medicare benefits by mail

If you can’t claim at the doctor’s office or online, you can claim by mail. To do this, complete a Medicare claim form and post it to us. The address is on the form.

When you submit your claim by mail, you’ll usually get your benefit within 21 days from when we receive it. We pay electronically into the bank account you have registered with us.

Claim a Medicare benefit over $10,000

If you need to claim an individual Medicare benefit of $10,000 or more, complete the Medicare claim form (MS014) and either:

• email or mail it to High Value Medicare Claim Services
• submit your claim at a service centre.

Claim Medicare benefits at a service centre

You can also make a claim at a service centre. When you do, we’ll pay the benefit into your bank account. So it’s important to make sure your bank details are correct. We’ll confirm your bank details when you make your claim.

If you submit your claim at a Service Centre, you’ll usually get your benefit within 21 days. We pay electronically into the bank account you have registered with us.

Claim Medicare benefits for someone else

You can claim for someone else if:

• they’re enrolled in Medicare
• you have paid for the service.

You don’t have to be on the same Medicare card as them.

You can claim for someone else by any of the following:

• at the doctor’s office
• by mail
• at a service centre.

You can claim online for someone else if they are on the same Medicare card as you.

If your Medicare online account is linked to myGov, sign in now and select Make a claim.

Sign in to myGov

You can also use the Express Plus Medicare mobile app.

If you don’t have a myGov account or a Medicare online account you’ll need to create them.

Track progress of your Medicare claims online

You can track the progress of Medicare claims online that you’ve recently submitted for yourself or someone else on your Medicare card. You can also track claims submitted by your health professional on your behalf, but not bulk bill claims.

You can do this using your Medicare online account through myGov. If your Medicare online account is linked to myGov, sign in and select View recent claims.

Sign in to myGov

You can also use the Express Plus Medicare mobile app.

You’ll be able to see the status of your claims online.

You’ll be shown one of the following messages:

• Submitted: Your claim was submitted successfully and will be processed by us.
• Completed: We’ve processed your claim. You don’t need to do anything else.
• Closed: Your claim can’t be processed or was cancelled by the health professional.

For more information about these claims, call the Medicare program.

Your claim will be displayed for 30 days after its completed or closed. You can view paid claims where you or a child under 14 were the patient in your Medicare claims history online. To get a copy, you can download a Medicare claims history statement.

Read more about how to understand your Medicare Claims History Statement.

Adjust a paid claim

If a claim paid to you is wrong, speak to the health professional that submitted it on your behalf.

This could include:

• incorrect patient details, date of service, charge or provider
• receiving a cheque in your provider’s name for a service you’ve paid in full.

Your health professional needs to contact us to have the claim adjusted manually.

If you have any questions, contact Medicare Program.

Statement of claim and benefit

You’ll get a statement of claim and benefit once your claim has been processed.

How you submit your claim for Medicare benefits will decide how you get your statement of claim and benefit.

Rejected claims

If we reject your claim, we’ll let you know. Reasons why we might reject a claim include:

• you or your doctor have already claimed it
• we need more details to assess your claim
• there was a mistake with your claim.

We may also reject a claim if you have already received the maximum allowable benefits for that service.

To find out more about why your claim was rejected, call the Medicare program.