This advice was received from Medicare in September 2016. It relates to rejections for specialist consultations with the reason code 605 - Referral expired - no benefit payable.

 

 

The Australian Government Department of Human Services have received an increase in calls in regards to specialist consultations that have been rejected with reason code 605.

 

The department would like to offer advice on preventing 605 rejections.

 

When submitting specialist consultations for services you must ensure you transmit the consultations with the correct referral period for the referring details supplied by the referring practitioner.

 

If your electronic claiming software defaults to a standard period (12 months) you may need to alter referral period in accordance to the referral period provided by the referring provider.

 

If you identify that an incorrect referral period has been submitted you will need to submit an adjustment form to have the claim details for the previous consultation altered to the correct referring period.

 

Find below links to the adjustment forms published on the department’s website - humanservices.gov.au

 

 

If an incorrect referral period is not corrected this can impact the patients future claims.

 

Should you have any queries regarding this advice please contact the Payment & Claiming Channel Management at dcm.support@humanservices.gov.au or on (02) 6143 7557.

 

 

In Access Anaesthetics, where a referral date has been entered on the Operation page, the Eclipse dialog box will show the default referral period, and provide options to change this.

 

 

For a standard referral ...

 

 

 

For a non-standard referral ...

 

 

 

There is also the option of an indefinite referral.

 

Note that this is only where there is a specific referral date entered. Otherwise, specialist procedures default to the 'referral override' option of 'Unspecified'. Other options may be selected where appropriate.