Understanding Medicare claim statuses
When you submit a Medicare claim through Praxi, the claim moves through a sequence of statuses as Services Australia (SA) processes it. Each status tells you something different about where the claim is and what — if anything — you need to do next. This page is the reference for every status you'll see in the Claims view, the Invoice detail, and the Payment Report.
If you've landed here from an error code, the Error Codes reference covers the resolution steps for specific rejection reasons.
Use the status shown in Finance to decide what needs attention. See Medicare claims in Finance for the queue labels Not sent, Sent, Approved, Paid, Rejected and Cancelled.
Quick reference
| Status | What it means | Action required |
|---|---|---|
| Processing | Praxi has accepted the claim and (for live claims) transmitted to SA. Assessment has not finished yet. | None — wait. Bulk-bill assessment is asynchronous (often hours). |
| Pending review (PEND) | SA accepted the claim but needs additional review before a benefit decision. | None on your side — SA will move it forward in 1-3 business days. |
| Pendable | SA needs your confirmation for a patient claim (PCIW only). The deadline is on the claim. | Open the pendable alert and confirm or abandon before the claim's expiry. |
| Pended | You confirmed a pendable claim. SA is reviewing the confirmed details. | None — wait for assessment. |
| Assessed | SA processed the claim and approved a benefit. Payment is on the way. | None — payment usually lands within 2-3 business days. |
| Paid | The benefit has been remitted to the practice or patient bank account. | Reconcile against your bank statement on the Payment Report. |
| Rejected (REJ) | SA refused the claim. The reason code and verbatim SA text tell you why. | Review the reason, fix the underlying issue, resubmit. |
| Deleted | You used Same-Day Delete (SDDW) on a same-day patient claim before SA finalised it. | None — claim is gone; resubmit if needed. |
Detail by status
Processing
The moment you click Submit in the Medicare Submit Sheet and Praxi accepts the claim, the stored status is usually Processing (not a separate "Submitted" label). For live claims, Praxi has handed the payload off to SA via MCOL; assessment may not have finished yet.
Typical lag from submission to first assessment is under five minutes for PCIW (patient claim interactive) and up to 24 hours for BBSW (bulk bill), which is store-and-forward.
You don't need to do anything at this stage. If the claim is still Processing after the timeframes above, check the Medicare error codes — sometimes SA's response gets stuck and the status doesn't refresh until the processing/payment report poll runs (about every 15 minutes).
Pending review (PEND)
SA accepted the claim into its processing queue but moved it to manual or extended review rather than auto-approving. Common reasons:
- A new patient whose Medicare card details haven't been seen by SA before.
- A claim that crosses a session-limit boundary (e.g. session 6 under MHCP, where SA may want to see the GP letter on file).
- A claim with an unusual MBS-item combination.
You don't need to do anything — SA generally clears PEND status within 1-3 business days. Praxi will refresh the status automatically.
Pendable (PCIW only)
For patient claims (fully paid and part-paid), SA occasionally returns a Pendable response. This is SA saying it needs the practice to confirm something before assessment continues.
You'll see a Pendable claim alert at the top of the Claims page with a countdown. Open the alert, review the details SA flagged, then:
- Confirm to accept SA's adjustment and let the claim proceed.
- Abandon to drop the claim — you can then resubmit with corrected details.
The deadline is per claim. Services Australia returns the window on each pendable response; Praxi does not invent a fixed "one hour for everyone" rule. The alert shows the exact expiry in your local timezone. If you don't act in time, the claim expires and you'll need to resubmit.
Bulk-bill claims are never pendable — only patient claims (PCIW) use this path. Same-day delete (SDDW) is also patient-claim only.
Pended
You've confirmed a pendable claim. SA is now applying the confirmation and moving the claim through final assessment. Same waiting time as Pending review above — usually 1-3 business days. No action required.
Assessed
SA has finished processing the claim and approved a benefit amount. You'll see the approved amount in the claim detail. Payment is on its way.
For bulk-bill (BBSW) claims, payment lands at the practice bank account. For patient claims (PCIW), payment lands at the patient's bank account (or yours, depending on the claim type — Fully Paid vs Part Paid).
Typical time from Assessed to Paid is 2-3 business days. SA pays in batches overnight on weekdays.
Paid
The benefit has been remitted. The Payment Report at Medicare payment report shows paid claims grouped by the date SA remitted, which lines up with your bank statement.
For reconciliation:
- Open the Payment Report.
- Filter by the date range you're reconciling.
- Each row is one day's remittance from SA.
- Expand a row to see the underlying claims that made up the payment.
- Match the day's total against the corresponding deposit on your bank statement.
Rejected (REJ)
SA refused the claim. The claim's error code tells you why, and the Error Codes reference explains how to fix each one.
Common rejection situations:
- Card details don't match SA's records — the Medicare number, IRN, or name on the claim disagrees with what SA holds.
- Provider number issue — the provider number isn't endorsed or registered for the item or location you claimed.
- Patient not eligible — the patient isn't Medicare-eligible for the service on the date claimed.
- Referral missing — the MBS item needs a referral and one isn't on file.
SA's numeric reason codes change over time, so Praxi shows SA's verbatim reason text on the claim rather than relying on a fixed code table — the Error Codes reference maps each situation to its fix. Once you've fixed the underlying issue, resubmit the claim — Praxi creates a fresh claim attempt so SA doesn't see it as a duplicate.
Deleted
If you submitted a patient claim (PCIW) by mistake — wrong item, wrong patient, wrong amount — you have until the end of the calendar day (AEST) to delete it via Same-Day Delete. After that, SA's records lock in and you need to lodge a Medicare correction request through a different channel.
A deleted claim doesn't trigger payment and doesn't show up in your Payment Report. Resubmit a fresh claim once you've corrected the issue.
Spotting claims that need attention
Claim lists colour-code statuses for fast scanning — paid claims read as positive, rejected claims as urgent, and pendable claims carry a highlighted alert with their countdown.
The Processing Report at Medicare processing report shows assessed-but-not-yet-paid claims so you can spot rejections or pendable states early, before the payment remittance arrives.
Bulk bill vs patient claim — status differences
BBSW (bulk bill) and PCIW (patient claim) flows are mostly identical, but two statuses are exclusive to PCIW:
- Pendable — only patient claims can be pendable.
- Deleted (SDDW) — same-day delete only works for patient claims that SA has already assessed (TECH.SIS.MEDICARE.05). Bulk-bill claims cannot be same-day deleted.
Bulk-bill claims that need SA review go to Pending review (PEND) or stay in Processing until the processing report lands — they never enter the pendable confirmation window.
DVA allied health (VAAW)
DVA psychology claims (service type code K, not Medicare's specialist S)
use the same high-level path as Medicare bulk bill, with these extras:
- Every DVA psychology claim needs a referral block (TECH.SIS.DVA.02 §4.8) — Praxi blocks submission without one.
- DVA payments process through Assessed → Paid, but the bank account on file with DVA receives the payment, not the patient.
- DVA Gold Card holders are eligible for clinically necessary care; DVA White Card holders require an accepted-disability code on the claim, which Praxi validates before submission.
See DVA Claims for the full workflow.
When a status doesn't change
If a claim has been stuck at the same status for longer than the timeframes above, the most common causes are:
- Report poll lag — Praxi polls SA's reports every 15 minutes to refresh statuses. Look at the timestamp on the claim detail; if it's more than 30 minutes old, our team is alerted automatically.
- SA upstream incident — occasionally SA's processing pipeline has a delay or outage. Check status.servicesaustralia.gov.au if you suspect this.
- PRODA auth issue — if our authentication with SA has drifted, the claim is stuck because Praxi can't poll its status. Our team is alerted automatically; contact support if you see it.
If you're still stuck after 24 hours, open a ticket via Help → Contact Support and reference the claim ID — we can investigate it for you.
Related
Verified against the current Praxi product surface, MCOL response semantics (TECH.SIS.MEDICARE.01 V2.1.9 — Common Rules; TECH.SIS.MEDICARE.02 V2.1.4 — BBSW; TECH.SIS.MEDICARE.04 V2.1.6 — PCIW) on 2026-05-14.