All Online Claims (Bulk Bill, DVA, Patient Claim, Eclipse)

When Medicare payment is received for Bulk Bill/DVA and Private Claims (only Private claims when the Derived fee amount was not amended), Medicare calculates and handles the claim and as follows:

  • Medicare does not pay the Base item, and generates a reason code message. Example error message: '253 – Radiotherapy assessed with other item number on the voucher'.
  • Then Medicare Accepts the Derived item number and pays the amount (base item fee + derived item fee) and generates a reason code message. Example acceptance message: '516 – Benefit paid for base and derived radiotherapy items claimed'.Due to how Medicare handles the payment for the above scenario, MBS and RMFS fee List cannot generate a base item fee as $0.00. So, for a Private Patient the unpaid base item fee generates as a Gap value for the Practice.