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Private health insurance response codes

HealthPoint is the provider of private health insurance claiming on Smart Health terminals. This includes Overseas Student Health Cover and Overseas Visitors Health Cover claims.

When you process a private health insurance claim, the response code will indicate the status or outcome of this claim. Response codes can apply to the entire claim or individual items in the claim.

HealthPoint claim response codes

Code
Message
What it means 
What to do
0
Approved
The claim has been approved
-
1
Provider not approved
The health fund has not approved the selected provider
Call the Smart Health support team to check your provider registration
2
Contact fund
The health fund should be contacted
Contact the health fund
3
Invalid provider number
The provider’s ID is not valid
Resubmit your provider registration following the steps in the Smart Health Hub User Guide To remove incorrect provider registration, call the Smart Health support team
4
Please retain card
The health fund requests the practice keep the private health insurance fund card
Keep the patient’s card and contact the health fund
10
Refer claim to fund
The health fund requests this claim be referred to them directly
Do not process via Smart Health terminal and contact the health fund for next steps
12
Transaction declined
The claim was declined by the health fund
Contact the health fund for more information
14
Card no is not valid
The patient’s health fund card is no longer valid
Contact the health fund for more information
15
Items not accepted
An item on the claim is not valid
Edit the claim and resubmit it with valid items
19
No items entered
The claim was submitted without items
Add items to the claim and resubmit it
21
Contact help desk
The system has not actioned the claim
Call the Smart Health support team
25
Unable to find claim
The claim could not be retrieved from the health fund
Contact the health fund
30
System data error
A system error has occurred
Reject the current claim and process it again
If the message persists, contact the health fund
32
Completed partially
Not all items on the claim have been successfully claimed
Check assessment details in claim summary
Contact the health fund for more information
40
Membership not covered
The patient’s membership does not cover the services provided
Tell the patient to check their cover with their health fund
42
Membership ceased / susp
The patient’s membership policy and coverage has ceased or been suspended
Tell the patient to check their cover with their health fund
51
Membership not financial
The patient’s membership has not been paid
Tell the patient to check their cover with their health fund
54
Card has expired
The patient’s health fund card has expired
Tell the patient to contact their health fund
56
Invalid membership no
The health fund does not recognise the card
Ask the patient to use their digital health fund card (if they have one) otherwise discard the claim and resubmit it.

If the message persists, tell the patient to contact their health fund
57
No ancillary cover
The patient does not have ancillary cover
Tell the patient to check their cover with their health fund
58
Trans not permitted
The system cannot process this transaction
Try again and if the message persists, contact the health fund
60
Provider not known by fund
The health fund does not recognise this provider
Call the Smart Health support team to check your provider registration
61
Benefit limit exceed
The patient’s benefit limit has been exceeded for the period specified in their policy
Tell the patient to check their cover with their health fund
69
No benefit payable
No benefit is payable for the claim
Tell the patient to check their cover with their health fund
76
Not same day as claim
The claim you’re attempting to cancel was not created today
Claims cannot be cancelled after claim date
80
Payment required by employer
The policy is linked to an employer
Tell the patient to contact the health fund for support with employer-related claims
81
Unable to locate claim
The health fund is unable to retrieve the claim
Try again and if the message persists, contact the health fund
82
Claim already paid
The claim has already been approved and paid
Contact the health fund for more information
83
Too many patients
The number of patients in the claim exceeds the maximum permissible in a claim
Resubmit the claim with fewer patients
84
Requires manual invoice
The claim cannot be submitted electronically via Smart Health
Do not process via Smart Health and contact the health fund for further instructions
91
System busy try again
The health fund is receiving high volumes of claims
Try again in a few minutes and if the message persists, contact the health fund
92
System unavailable
The health fund’s system is not responding to the patient’s claim
Try again and if the message persists, contact the health fund
93
System problem
The system is experiencing a problem
Try again and if the message persists, contact the health fund
94
Duplicate transmission
The claim is a duplicate of a previous claim
Try again and if the message persists, contact the health fund
P0-PZ
Health fund specific
The health fund may send a notification via a response code between P0 – PZ
Contact the health fund for more information

HealthPoint item response codes

Code
Message
What it means
What to do
00
Approved
The item has been approved
–
01
Benefit not payable
No benefit is payable for this item
–
02
Restricted item
No benefit is payable for this item because the rebate for this item is restricted by the patient’s policy
Tell the patient to check their cover with their health fund
03
Restricted item
A reduced benefit is payable for this item because the rebate for this item is restricted by the patient’s policy
Tell the patient to check their cover with their health fund
04
Previously paid
A benefit has already been paid for this item
Tell the patient to check their cover with their health fund
05
Benefit limit reached
The patient has exceeded their benefit limit for this item in the policy period, so no benefit has been paid
Tell the patient to check their cover and limits with their health fund
06
Benefit limit reached
The patient has exceeded their benefit limit for this item in the policy period, so a reduced benefit has been paid
Tell the patient to check their cover and limits with their health fund
07
Within waiting period
The patient does not qualify for this item because they have not completed the waiting period specified in their policy
Tell the patient to check their cover and waiting periods with their health fund
08
Prereq srvce required
A prerequisite service is required before benefits are payable for this item
Tell the patient to check with their health fund what’s required to qualify for the benefits
09
Pre-existing condition
No benefit is payable as this item applies to a preexisting condition
Tell the patient to check with their health fund what benefit restrictions apply for treatment
10
Item no. Is not valid
The health fund does not recognise this item number
Refer to an up-to-date list of the current items
11
Item no. Ceased use
This item number is no longer in use (as of the date the service was provided)
Refer to an up-to-date list of the current items
12
Item not for provider
The health fund will not pay benefits for this item when claimed by this provider
Check with the health fund what status you need to provide this service
13
Item no. Not approved
The health fund does not approve this item so no benefits have been paid
Check the item number is correct
14
Item max use exceeded
The health fund limits how many times this item can be used in a set period, and the patient has exceeded this limit
Tell the patient to check their cover and restrictions with their health fund
15
Service fee missing
The health fund will not approve any payment for this item unless you supply the service fee charged for this item
Modify the claim and include the service fee
17
Service date too old
The service date provided for this item is too far in the past
Check the date of service provided and if it’s correct, tell the patient to make a manual claim with their health fund
18
Body part is required
A body part is required for this item and has not been provided
Modify the claim and enter the body part
19
Patient not covered
The patient was not covered for this service (as of the date the service was provided)
Tell the patient to check their cover with their health fund
20
No dependent status
The patient is not covered because their dependent status on the policy ended before the service was performed
Tell the patient to check their cover with their health fund
21
Invalid patient no
The patient’s reference number was incorrect
Check the patient number on the health fund card. For some fund cards, the first patient on the card is number 0. Correct the claim and resubmit it
22
Membership not covered
The patient’s membership does not cover the services provided (as of the date the service was provided)
Tell the patient to check their cover with their health fund
23
Membership ceased/ susp
The patient’s membership or policy has ceased or been suspended (as of the date the service was provided)
Tell the patient to check their cover with their health fund
24
Membership unfinancial
The patient’s fund membership has not been paid (as of the date the service was provided)
Tell the patient to check their cover with their health fund
25
No ancillary cover
The patient does not have ancillary cover (as of the date the service was provided)
Tell the patient to check their cover with their health fund
26
Item not covered
The patient was not covered for this item (as of the date the service was provided)
Tell the patient to check their cover with their health fund
27
Possible duplicate
The item may be a duplicate
Contact the health fund for more information
28
Excess applied
No benefit has been paid for this item because an excess applies
Tell the patient to check their cover with their health fund
29
Excess applied
A reduced benefit has been paid for this item because an excess applies
Tell the patient to check their cover with their health fund
30
Quotation required
No benefit has been paid for this item because a quote must be supplied to the health fund prior to this item being claimed
Tell the patient to check their cover with their health fund
31
Quotation required
A reduced benefit has been paid for this item because a quote must be supplied to the health fund prior to this item being claimed
Tell the patient to check their cover with their health fund
32
Exceeds quotation
No benefit has been paid for this item because the fee for this item exceeds the quote given
Tell the patient to check their cover with their health fund
33
Exceeds quotation
A reduced benefit has been paid for this item because the fee for this item exceeds the quote given
Tell the patient to check their cover with their health fund
34
Age restriction
No benefit has been paid because the health fund applies an age restriction to this item
Tell the patient to check their cover with their health fund
35
Age restriction
A reduced benefit has been paid because the health fund applies an age restriction to this item
Tell the patient to check their cover with their health fund
36
Gender restriction
No benefit has been paid because the health fund applies a gender restriction to this item
Tell the patient to check their cover with their health fund
37
Gender restriction
A reduced benefit has been paid because the health fund applies a gender restriction to this item
Tell the patient to check their cover with their health fund
38
Invalid charge
No benefit has been paid because the health fund deems the charge for this item invalid
Contact the health fund for more information
39
Notional charge
No benefit has been paid
Contact the health fund for more information
40
Converted item
No benefit has been paid
Contact the health fund for more information
41
Refer to fund
No benefit has been paid
Contact the health fund for more information
42
System problem
The system is experiencing a problem
Check notifications from HealthPoint in the Smart Health Hub
50
Provider not known
The health fund does not recognise this provider
Call the Smart Health support team for more information
51
Not allowed for prov
The health fund does not pay benefits when this service is performed by this provider
Tell the patient to check their cover with their health fund

CommBank Smart Health error codes

Smart Health terminal error codes

Code
What it means
What to do
T001
Card is not supported
Check the patient’s health fund card and try again.
T000 - T018
Card related status code
Ask the patient to try another card
1004 or 900
System error
Follow the prompts on screen and if the message persists, call the Smart Health support team
400 or 5112
Provider is not properly registered
Resubmit your provider registration following the process outlined in the Smart Health Hub User Guide. To remove incorrect provider registration, contact the Smart Health support team
1003
Code entered has multiple certificate
The pairing access code expires after 3 minutes, and a new code may be required. For more about pairing your terminal with Smart Health Hub, refer to the Smart Health Hub Guide
1004
Code entered has no certificate
Refer to Smart Health hub guide to follow the process of terminal pairing with Smart Health Hub
1005
Code entered is invalid
The pairing access code expires after 3 minutes, and a new code may be required. For more about pairing your terminal with Smart Health Hub, refer to the Smart Health Hub Guide
5063
Medicare claim has exceeded the number items allowed to raise claim
Ensure each Medicare claim does not exceed 14 items. Adjust the number of items on the claim and resubmit it
5114
Code entered is expired
The pairing access code expires after 3 minutes, and a new code may be required. For more about pairing your terminal with Smart Health Hub, refer to the Smart Health Hub Guide
5131
Private health insurance (PHI) claim has exceeded the number items allowed to raise claim
Ensure each private health claim does not exceed 15 items. Adjust the number of items on the claim and resubmit it
8888
Signature failed to save
Retry claim and ask the patient to sign on screen when prompted. If the message persists, call the Smart Health support team
9201
Invalid format for data item
Ensure all required fields are filled out and formatted correctly
9998
HealthPoint communication error
Check for outage notifications in Smart Health Hub. If the message persists, call the Smart Health support team
9999 or no code
Network or system error
Check the power chord is plugged in and Wi-Fi is enabled. If the message persists, call the Smart Health support team
Card not supported
Error processing a Medicare rebate
Make sure the patient's debit card is inserted or swiped for processing of Medicare rebate

Have you tried restarting your terminal?

We know it sounds simple, but we’ve found restarting your EFTPOS terminal can fix the problem about 40% of the time.

Follow these instructions if you’re not sure how to restart your terminal.

Other helpful hints

    • If you’re having trouble connecting your terminal, check if we’ve reported any system outages or issues before contacting us
    • For some terminals, you may need to check your terminal can successfully log on. Follow the instructions in the user guide for your terminal
    • Always check the card issue and expiry dates
    • Always check the transaction amount matches the ‘Approved’ amount on the receipt before handing it to the customer
    • Always refund to the same card that was used for the original purchase

Need more help?

  • Call our dedicated Merchant Helpdesk on 1800 230 177, available 24/7. To ensure we can help you as quickly as possible, have the following information ready:

    • Terminal ID (located at the top of your merchant receipt)
    • Trading name
    • Trading address
    • Trading phone number

Things you should know

This information is intended to provide general information of an educational nature only. It does not have regard to the financial situation or needs of any reader and must not be relied upon as financial product advice. You should consider seeking independent financial advice before making any decision based on this information. The information in this user guide and any opinions, conclusions or recommendations are reasonably held or made, based on the information available at the time of its publication but no representation or warranty, either expressed or implied, is made or provided as to the accuracy, reliability or completeness of any statement made in this article.