Online Patient Verification - Error Codes

Code 

Message 

Reason 

Action Required 

0 

Patient known to fund 

Patient details supplied are correct as at the day processed.  Patient details can be used to; 

1. Obtain an eligibility check 
2. Process a hospital claim 

1005 

Facility Id not known to 

Fund 

The facility Id supplied is; 

1. Not registered at the Fund 2. Not current. 

Check the Facility Id, if correct contact the Fund, if incorrect resubmit with corrected data. 

1007 

Account Reference Id or Hospital Admission number required 

The account reference or hospital admission id is missing. 

Add the account reference or hospital admission id and then resubmit. 

1100 

Not eligible for service selected 

The Patient is not eligible to have treatment for the presenting illness or item according to the information supplied in the eligibility check. 

Inform the patient that they are not eligible for the service. 

1101 

Eligible for service selected 

Patient is eligible for the presenting illness or item according to information supplied in the eligibility check 

1102 

Eligible subject to conditions 

Patient maybe eligible for the presenting illness or item according to the information supplied in the eligibility check however there is a condition you will need to note before you proceed.  This could be (not exhaustive); 

1. Financial status 
2. Reduced benefit is payable 
3. Possible pre-existing condition 

Refer to OEC guide for assistance on what areas to check. 

1103 

Resubmit for new assessment if presenting illness is shown 

A general presenting illness or item was input on the request and therefore a general answer displaying all benefit limitation or restriction that apply to the patients cover was returned in the response. 

Check the Eligibility response carefully and resubmit if the actual presenting illness or item is display to obtain an accurate assessment.  

1104 

Eligible for service selected at previous cover 

The patient is eligible for the presenting illness or item as input on the incoming eligibility request however not at their current cover.  This message generally results where the patient is still serving the required waiting period applicable on the upgrade in cover. 

The patient is eligible for the service on their previous level of cover. 

1105 

Not eligible for service selected – Wait period applied 

The patient is not eligible for the presenting illness or item as they have not completed serving their required waiting periods. 

1106 

Eligible for service selected at previous cover – Wait period applied 

The patient is eligible for the presenting illness or item as input on the incoming eligibility request however not at their current cover.  This message generally results where the patient is still serving the required waiting period applicable on the upgrade in cover. 

1107 

Not eligible for service selected – Pre Existing Ailment 

The patient is not eligible for the presenting illness or item if it IS deemed to be a pre-existing condition 

Ask the member to contact the Fund to get the pre-existing ailment process started. 

1108 

Eligible at previous cover subject to conditions 

The patient is eligible for the presenting illness or item as input on the incoming eligibility request however not at their current cover.  This message generally results where the patient is still serving the required waiting period applicable on the upgrade in cover. 

1109 

Eligible subject to approval of accident certificate 

Fund will not guarantee payment of the service until an accident certificate has been supplied and approved. 

Ask member to contact the Fund. 

1110 

Eligible subject to conditions and approval of accident certificate 

Fund will not guarantee payment of the service until an accident certificate has been supplied and approved AND there is another condition that will affect assessment.     This could be; 

1. Financial status 
2. Pre-existing ailment or waiting period 
3. Reduced benefit is payable 

Ask member to contact the Fund regarding the accident certificate and to verify the other conditions as per the eligibility response. 

1999 

Contact Fund 

3040 

RHBO system 

unavailable or service problems 

RHBO system may be undergoing scheduled maintenance or experiencing service difficulties. (May be set by hub or health fund system.) 

Try again later 

9663 

Member Number not recognised by fund 

Member number not known by the Fund the claim was submitted to. No other patient data checked at this time 

Check member number and fund, correct whichever is in error and try again 

9665 

Patient not recognised on the membership 

Member number is valid. Cover for membership number is okay 

Either no patient is identified or multiple patients are identified. 

Check patient details and re-submit. (Make change to the alias name if 

Medicare have sent back a successful response). (Provide sufficient patient 

details to ensure unique match within membership. 

9666 

Member to contact fund 

Possible fraud or accident claim or membership issues 

Member to contact fund 

9667 

Cover is suspended or cancelled 

Member Number is valid 

Cannot lodge a medical claim, as member is not covered for that service. 

Check with member. 

9668 

Inappropriate Cover 

Cover is either Ancillary or 

Ambulance only 

Cannot lodge a medical claim, as member is not covered for that service. 

Check with member. 

9669 

Patient is ceased or pending cessation 

Member Number is valid. Appropriate cover for membership number. 

Patient details matched. 

Member to contact fund. Patient may not have current student registration 

9671 

Location/provider not authorised to use channel at fund 

Location/Provider could be 

suspended or not registered for ECLIPSE 

Provider to contact fund 

9686 

Baby not known at Fund 

No patient match can be found and the DOB of the patient is LESS than 29 days from the earliest date of service in the OPV. 

Member needs to register the baby at the fund.