Handling Medicare Verification Warnings and Errors

Handling Medicare Verification Warnings and Errors

Verifying a patient's Medicare Card details may result in a complete match, resulting in a green "Verified" date.

It's important to note that Medicare verifications don't require the family name to match if the other factors (first name, DoB, Medicare Card) are correct, so it is possible to get a green "Verified" result even if the surname is misspelled or totally wrong.

When Medicare returns updated details, the "Verified" date will display in orange. See the History tab for details. The software will update the details if possible and use them in claims. You can optionally re-verify with the revised details by clicking on the Refresh icon to the right of Medicare number.

Usually you can proceed to make a claim with a verification warning but not with a verification error.



Warning Codes include:
  1. 8015 - Old or Wrong Medicare Card - Medicare Card Number has been updated.
  2. 8016 - Wrong Medicare IRN - IRN has been updated
  3. 8017 - Wrong Given Name - The given name that Medicare knows the patient by will be stored on the patient's record
  4. 8018 - Wrong Date of Birth - this can't be resolved without manual intervention see this article
  5. 8019 - Wrong Card and Given Name
  6. 8020 - Wrong Card and IRN
  7. 8021 - Wrong Card and Date of Birth 
  8. 9633 - Replacement Card has been issued
Error Codes will display a red "Verification Error". In this case you won't be able to submit claims until the error is corrected.



Codes include:
  1. 9649 - Undetermined Eligibility - patient must contact Medicare
  2. 9650 - The card number and/or patient details submitted did not match Medicare checks.
  3. 9675 - Expired Medicare card - patient must contact Medicare.
For the latter 2 this may indicate that a new card has been issued, in this case you could try incrementing the last digit of the 10-digit card number by one to check if a new card has been issued. Sometimes this happens automatically (eg code 8015 above).

    • Related Articles

    • Handling Error 8018 - Date of Birth doesn't match Medicare Records

      If a Medicare verification returns an error code 8018 it means that the patient's date of birth entered doesn't match Medicare records. You will not be able to submit a claim for this patient until it is resolved. Check you've correctly entered the ...

    • Registering providers with Medicare

      Overview Before you can submit electronic claims, all providers must be registered with Medicare for online claiming. There are two ways to manage this. Via the provider's PRODA account, suitable for single providers or small numbers of providers ...

    • Billing Accurately Under Medicare

      While the support staff at Cutting Edge are happy to provide general advice about how to correctly bill Medicare for medical services, it's the responsibility of the servicing provider to ensure that all services for their provider numbers are billed ...

    • How to report incorrect Medicare payments

      It is the servicing provider's responsibility to advise Medicare if you are aware of incorrect Medicare payments, using the Voluntary acknowledgement of incorrect payments form  ...

    • Handling two or more identical services on the same day with Not Duplicate Service flags

      Medicare checks that electronic claims are not duplicates of other claims that have already been paid. This can cause issues where a patient requires more than one consultation on the same day, or is taken back to the operating theatre. To improve ...