| Code | Receipt Print Out | Description | Next Step |
|---|---|---|---|
00 | Approved (8) | Approved or completed successfully | Patient to follow up with fund |
| 01 | Prov Not Approv (15) | Provider not approved by fund | Patient to follow up with fund |
| 02 | Mship Under Invest (19) | Membership under investigation | Patient to follow up with fund |
03 | Invalid Prov Nbr (16) | Invalid provider number | Patient to follow up with fund |
04 | Previously paid | Nil benefit – benefit previously paid | Patient to follow up with fund |
05 | Limit reached | Nil benefit – limit reached | Patient to follow up with fund |
06 | Limit reached | Reduced benefit – limit reached | Patient to follow up with fund |
07 | Waiting Period | Nil benefit - qualifying period applies | Patient to follow up with fund |
08 | PreReq Ser Reqd | Nil benefit – pre-requisite service required | Provider to follow up with fund |
09 | Pre Existing | Nil benefit – pre-existing ailment | Patient to follow up with fund |
10 | Item Nbr Invalid | Item number invalid | You haven't entered a correct number. Please check the HICAPS item guide |
11 | Item Nbr Ceased | Item number ceased | Provider to check item guide |
12 | Item Not Valid | Item not valid for provider | Provider to check item guide |
13 | Item Not Apprvd | Item not approved – not payable by HICAPS | Patient to follow up with fund |
14 | Max Nbr Ser Exc | Service exceeds number of times permitted | Patient to follow up with fund |
15 | Cost Missing | Cost must be entered | Value needs to be entered in 0.05c increments |
16 | DOS Not Valid | Date of service must be before today | Provider to follow up with Help Desk |
17 | DOS too Old | Date of service too old | Patient to claim directly with fund |
18 | Clincl Code Rqd | Clinical code required | Provider to check item guide |
19 | Pat Not Covered | Patient not covered for this type of service | Patient to follow up with fund |
20 | Depd Status End | Dependent status ceased | Patient to follow up with fund |
21 | Invalid PAT Code | Invalid patient code | Provider to check patient details on card |
22 | Mship Not Covere | The member is not covered for the service | Patient to follow up with fund |
23 | Mship Ended DOS | Membership has ceased or is suspended at the date of service | Patient to follow up with fund |
24 | Mship Unfin DOS | Membership not current at date of service | Patient to follow up with fund |
25 | No Ancill Cover | The patient has no ancillary cover | Patient to follow up with fund |
26 | Item Not Coverd | The patient is not covered for this service | Patient to follow up with fund |
27 | Duplicate Serv | Duplicate service already processed | Patient to follow up with fund |
28 | Excess on Serv | Nil benefit – excess on service applied | Patient to follow up with fund |
29 | Excess on Serv | Reduced benefit – excess on service applied | Patient to follow up with fund |
30 | Quote Required | Nil benefit – excess on service applied | Patient to follow up with fund |
31 | Quote Required | Reduced benefit – quote required prior to service | Patient to follow up with fund |
32 | Exceeds Quote | Nil benefit – claim exceeds quote | Patient to follow up with fund |
33 | Exceeds Quote | Reduced benefit – claim exceeds quote | Patient to follow up with fund |
34 | Age Restriction | Nil benefit – age restriction applies | Patient to follow up with fund |
35 | Age Restriction | Reduced benefit – age restriction applies | Patient to follow up with fund |
36 | Gender Restrict | Nil benefit – gender restriction applies | Patient to follow up with fund |
37 | Gender Restrict | Reduced benefit – gender restriction applies | Patient to follow up with fund |
38 | Invalid Charge | Nil benefit – amount charged is invalid | Provider to follow up with fund |
39 | Notional Charge | Notional charge | |
40 | Converted Item | Converted item | |
41 | Refer to Health Fund | Refer to fund | Patient to follow up with fund |
42 | System Problem | System problem | Provider to follow up with Help Desk |
43 | Tran Declined | Transaction declined – refer tran to resp code | Refer to transaction response code |
44 | Medical Certificate | Required Medical | Crt Req |
45 | Invalid Tooth ID | Invalid Tooth ID |
|
50 | Prov Not Appro | Provider not approved by fund (at date of service) | Provider to follow up with Help Desk |
51 | Prov Not Appro | Provider not approved by fund for this service at DOS | Provider to follow up with Help Desk |
52 | Tooth id Reqd | Tooth ID number required | Provider to check item guide |
53 | DOS before Injury | Service date before injury date | Patient to follow up with fund |
54 | Submitted | Transaction submitted for processing | No Further action required |
55 | ICD 10 Required | ICD 10 Required |
|
56 | Charge Exceeds Agreed Maximum | Chg Over Agreed |
|
57 | Approved –item | requested amount has been adjusted | Approved–Amt Adj |
58 | Non Telehealth Item Number Used | Non TeleH Item |
|
Po-PZ | Refer to Fund | Refer health fund – Not 1 | Patient to follow up with fund |
Note: Item codes in the range P0 – P9 and PA – PZ indicate that an item has been declined by the Health Fund for a specific reason. These items must be followed up directly with the Fund.