The table shows:
- common data elements or fields and their descriptions and use
- the type of claims where you should fill in the field
- which health professional can use this field or data element with the claim type.
If you’re using the integrated solution, the fields where you enter data on your EFTPOS terminal or practice management software may be different. Refer to your software vendor, financial institution or software help guide for more information.
Use the filter box to look up common fields.
| Field | Description and use | Who can use it |
|---|---|---|
| Service type code | Health professionals have to enter information in a claim to distinguish which type of service they’re submitting. Use different values depending on the type of service you’re claiming:
| General practitioner (GP) Specialist Diagnostic Pathology |
| Item override code | Sometimes health professionals have to give more information in a claim so that we can assess the service. The item override code lets health professionals submit information for specific situations. It uses a 2-character indicator so that we correctly assess the service and pay the right amount. 2-character values include:
| General practitioner (GP) Specialist Diagnostic Pathology |
| Restrictive override code | Sometimes health professionals have to provide more information in a claim so that we can assess the service. The restrictive override code lets health professionals submit information for specific situations. It uses a 2-character indicator so that we correctly assess the service and pay the right amount. 2-character values include:
| General practitioner (GP) Specialist Diagnostic |
| Patient contribution amount | The patient contribution amount is for when a claimant has made a part payment contribution towards the account. It’s only required if the account paid ndicator is set to N. It shows values in cents, for example 99999 = $9,999.99. | General practitioner (GP) Specialist Diagnostic |
| Location Specific Practice Number | Only use a Location Specific Practice Number (LSPN) with:
This field is mandatory if these services occur. For example, if a health professional is performing diagnostic imaging services in a remote location they should include the LSPN when lodging the claim. An LSPN is 6 numbers. | General practitioner (GP) Specialist Diagnostic |
| Referral issue date | The referral issue date is the date that the referring provider issued or wrote the referral. It must be in the format of YYYYMMDD. | Specialist |
| Referral period type code | The referral period type code shows how long referrals are valid for:
| Specialist |
| Referral override type code | The referral override type code is for when a health professional is lodging a claim and need to indicate why they provided referral services without referral from another health professional. The values to choose from are:
| Specialist |
| Request issue date | The request issue date is the date the requesting provider issued or wrote the request. It must be in the format of YYYYMMDD. | Diagnostic Pathology |
| Request type code | Health professionals have to enter information in a claim to distinguish which type of service they’re requesting. Some values they can use to request are:
| Diagnostic Pathology |
| Request override type code | The request override type code is for when a health professional is lodging a claim and they need to indicate why they provided referral services without referral from another health professional. The values to choose from are:
| Diagnostic Pathology |
| Self-deemed code | Self-deemed (SD) is an optional element for diagnostic and pathology claims. When the SD value is present, you can’t set request details.
| Diagnostic Pathology |
| Specimen Collection Point | The Specimen Collection Point (SCPId) identifies the site where the pathology specimen was collected. Note: This field is only available in bulk billing. | Pathology |
Contact the Developer Support and Online Technical Support (OTS) team for software vendors for specific technical enquiries.