KB-017IntegrationsTroubleshooting

Medicare claim rejections — common causes and fixes

Most rejections fall into five patterns, and four of them are fixable at the front desk without calling anyone. Work the pattern first, then the code.

First: how claiming works, in one paragraph

Curaeon does not talk to Medicare Online. Claiming goes through Tyro Health Online: a queued claim on an invoice has a Send to Medicare… button, which shows exactly what will be sent — or names the fact that blocks it — and, once your practice's Tyro onboarding is complete, opens Tyro's own claim form (KB-058 — What Curaeon connects to Services Australia today (AIR, IHI, PBS authorities, Medicare, MyMedicare), and the manual workaround for each). There are no batches, and nothing runs overnight.

Then: find the rejection detail

Open the invoice from Billing and look at its Medicare claims block. Each claim shows its state on the right, and a rejection shows its code and reason in the same line, where "Queued — ready to send" was. They are Services Australia's words, and they tell you which pattern below you're in.

An invoice's Medicare claims block: the claim's state sits on the right, and a rejection's code and reason replace "ready to send".

The five patterns

1. Patient details don't match Medicare's records (most common) Name spelling, date of birth, or an old Medicare card number after a reissue. Fix: verify against the patient's current card or their Medicare Express Plus app details and correct the patient record. Utilities → Data quality lists active patients with no Medicare number or date of birth — worth clearing while the patient is at the desk (KB-081 — Fix data-quality gaps before they become rejected claims or lost letters). The manual does not describe a one-click resubmit, so if you are unsure whether raising the claim again could duplicate it, check with support first.

2. Entitlement or concession has lapsed Card expired, or a concession (health care card, DVA) no longer current. Curaeon has no built-in eligibility check — it does not query Medicare in real time. Fix: confirm with the patient's current card or in the Services Australia portal, update the record, and claim again — or discuss private billing with the patient.

3. Provider number problems New registrar not yet set up, a provider number used at the wrong location, or a locum's number lapsed. Fix: each practitioner's provider number is under Settings → Users. The Send to Medicare… preview names a missing provider number or individual reference number before anything is sent, so this is usually caught at the desk. Changing the number itself with Medicare is a Services Australia process.

4. Item number restrictions The item conflicts with another service (same-day restrictions, frequency limits, age or duration requirements). Fix: a billing-rules question, not a technical fault — check the MBS item descriptor, correct the invoice and claim again. Curaeon never suggests an item (KB-056 — Why the scribe never writes the Assessment or suggests item numbers): what was claimed is what somebody chose. Repeated rejections on the same item across patients are worth a ticket; Utilities → Clinical datasets shows which MBS data your server has loaded.

5. The claim will not send at all (the only genuinely technical pattern) Send to Medicare… does not open Tyro's form, or opens it and it fails, or claims sit unchanged for hours after being sent. Do not keep pressing the button. Raise a ticket with the invoice number and the time; if Tyro's own service is the problem we will tell you. Consulting continues regardless.

Return codes

The code and reason on the invoice are Services Australia's. We do not reproduce their return-code table here — a stale copy is worse than none. Read the reason, match it to a pattern above, and look the code up in Services Australia's own reference if the reason is not enough. If a code keeps recurring at your practice, tell us on a ticket.

When to raise a ticket

Pattern 5, the same code across many patients on the same day, or a rejection whose reason you cannot map to a pattern. Include the invoice number and the code — never the patient's details (KB-007 — Why we never need patient details in a support ticket).

Raise it: support.curaeon.com.au → Raise a ticket, starting the one-line summary with "Medicare claim". If claiming is down entirely during consulting hours, say so in the summary or call 1300 XXX XXX.