MBS claims rejected due to aftercare

23 Mar 2017

GPs who have experienced a claim rejection due to aftercare may wish to note that the Department of Human Services has made changes to the application of the aftercare rule to Patient Claims Interactive (PCI) channel.

If you transmit a service where an aftercare period applies, you will receive a warning message of “9698 – Service is possible aftercare, check the account and resubmit with a valid indicator if not normal aftercare”.

If the service is aftercare, you cannot claim a Medicare benefit. If the service is not aftercare, you must indicate this by setting the Aftercare Override Indicator in your software. For help in determining what is and isn’t aftercare refer to the DHS Education Guide – Aftercare or post-operative treatment. If your software is unable to set the Aftercare Override Indicator, you may submit your claim using the Patient Claim Store and Forward (PCS) channel. You need to add “not normal aftercare” in service text (Notations include Not Normal Aftercare, NNAC and NNA).

Alternatively, you can now submit your patient claims online through Health Professional Online Services (HPOS) via webclaims.