Exception

Meaning

Action

1001 – Fund Payee ID not recognised by fund or other issues

For Medibank Private and AHM this error occurs because claims were sent as an Agreement rather than a Scheme claim type.

See exception Scenario 4: No Items Paid to deal with this rejected claim.

Then, refer to the ‘AHM & Medibank Private ECLIPSE Claiming’ guide in your ECLIPSE pack for instructions on correctly submitting Medibank Private and AHM claims through ECLIPSE.

For BUPA and their subsidiary funds this error occurs when Payee ID is not entered or is incorrect.

Refer back to the Setting Up Providers for ECLIPSE Claiming section.

Payee ID must be entered against BUPA and all subsidiary funds for all providers.  If it is entered and is correct, contact the fund.  If it is incorrect, amend and resubmit the claim.

For any other fund this error usually relates to an issue with fund registration.

Contact the health fund to find out where the problem lies and have it resolved.  Then, resubmit claims for payment.

2016 – Benefit for this service has been previously paid

Medicare believe a payment for this particular service has already been made.

See exception Scenario 4: No Items Paid to deal with the rejected claim.

If you do not believe the claim has been previously paid, or there is no record of this payment in Genie, contact the health fund to obtain a payment report. Once payment is confirmed, receipt invoice manually outside of ECLIPSE.

If account has been previously paid and is recorded in Genie against a duplicate of the account, delete the unpaid version of the invoice so only the original, fully paid, version remains in the system.

Receipting Error.

The amount claimed does not equal the amount paid for at least one of the services in the X claims(s) paid by this Remittance Advice. There may be Exceptions to Review. (Cancel Receipt)

Claims are linked by the ERA (electronic remittance advice) for receipting purposes. One of the claims on the remittance still needs to be reviewed.

Click View Payment and ascertain exactly which claims are associated with this Remittance Advice. Locate each claim in ECLIPSE and check whether Claimed and Paid amounts are equal.

Once the problem claim is identified click Review Exceptions (if claim is in Exceptions to Review) or View Processing Report (if claim is in Awaiting Remittance Advice or Ready to Receipt). Determine which Exception Scenario the claim fits in to (e.g. Scenario 2: Paid and Unpaid Items) then follow the steps in that section to resolve.