A 999 Exception code appears when a batch has been received and differences in the claims were identified. In this case Medicare doesn’t provide a reason why there were differences in the claim amounts and eClaims adds the exception code 999 to identify the item with the problem.

Most of the time Medicare does pay the claim but at a lower or higher rate. Some reasons could be:

• The 100% rebate for the item has been ticked for the item code, but Medicare only pays 85%
• Medicare rejected the item and didn’t provide a rejection code.

Go to the batch handler and click on the batch in red.

Click View to open the Batch Details screen and see the individual invoices.

Select the invoice with red text and click View to see a detailed view of the items in the invoice.

The Voucher Details screen shows the individual items and you will notice one of these items is red.

Medicare pay based on the item number regardless of the amount claimed. In some cases more or less may be paid by Medicare based on the item number and various rules.

Verify current MBS rates  www.mbsonline.gov.au 

The options to balance these payments are to either

• contact the patient and request payment
• send a manual claim through to the insurance company
• modify the invoice amount to be the same as the amount paid

To modify the amount charged click on the item so that it is highlighted.

Select Edit from the bottom of the screen.

Modify the Benefit to be the same as Payable

Click OK to save changes or Cancel to discard modifications and return to the previous screen.

Once the amount is modified to be identical to the amount payable the text colour will change from red to black. All modifications are updated to the patient invoice and reports automatically.

If you want to check it is working correctly. Push escape on the keyboard or Cancel in the Batch details screen to return to the Batch Details screen.

Click Treat to see the patient invoice and adjustment history. An adjustment should be displayed that corresponds with the modification that was just done.

Other error codes from Medicare click here.