We may reject claims for Medicare or Department of Veterans Affairs’ (DVA) benefits for reasons such as:
- an incorrect Medicare Benefits Schedule (MBS) or DVA Fees Schedule item has been used
- the patient has received the maximum allowable number of benefits for an MBS or DVA item
- the patient or health professional may not be eligible
- a system issue has occurred
- more information is needed to assess the claim.
When we reject a claim, we’ll give you a reason or return code. You can look up these codes to find a brief explanation for the rejection.
Once you know why your claim has been rejected, you can adjust or resubmit your claim.
For more information about Medicare reason codes, contact Medicare provider enquiries.